BACKGROUND: Rupture of an unscarred uterus is a rare and potentially catastrophic event. Common presenting signs and symptoms include abdominal pain, fetal heart rate abnormalities, and evidence of hypovolemia. CASE: A woman with a history of 2 prior uncomplicated first-trimester pregnancy terminations presented several years later at 32 weeks' gestation with abdominal pain and no other evidence of uterine rupture. Her clinicians suspected appendicitis, and computed tomography revealed a circular fundal uterine rupture occluded by extrusion of the fetal legs through the defect. Emergent cesarean delivery resulted in a good outcome for mother and baby. CONCLUSION: Clinicians should consider uterine rupture as a possible diagnosis when patients present with abdominal pain, even without common risk factors or other clinical evidence of a ruptured uterus. (J Reprod Med 2010;55:437-440)