Intramural ectopic pregnancy implanting in adenomyosis

The clinical course of this 33-year-old gravida presenting at 16 weeks' gestation with hemoperitoneum was typical for suspected uterine rupture. Pathologic examination of the hysterectomy specimen supports the diagnosis of intramural pregnancy, representing the 15th case reported to date in the literature. Furthermore, there was histologic evidence of adenomyosis both within the sinus tract leading to the implantation site and throughout the myometrium. Documentation of implantation and development of ectopic pregnancy in adenomyotic myometrium should alert the clinician to the possibility of this rare pregnancy complication.