Sir,Acute pain in abdomen during pregnancy presenting with shock can be due to various reasons. We encountered a 32-year-old G4P3L3 mother at 16 weeks of gestation in our emergency department who had pain in her abdomen and bilious vomiting lasting 3 days. Severe pallor was noted. The pulse rate was 110 min
−1and the blood pressure was 90/40 mmHg. Bowel sounds were absent. An emergency bedside ultrasound showed a fetus of 15 weeks 5 days of gestation in the right lumbar region along with free fluid and few dilated bowel loops. An emergency laparotomy was done, in which 2.5 l of hemoperitoneum was drained. A massive dilatation of small bowel loops and unicornuate uterus was noted with rupture of communicating rudimentary horn. The en-caul fetus, along with organized clot due to initial retraction of clot fibrin, was adherent in the vicinity of the cornual rent with the adjoining bowel loops and was found to be the cause of mechanical obstruction of the bowel proximal to it. Gentle removal of the fetus and the clots relieved the obstruction. The cornual rent was repaired. The patient stood the procedure well.We highlight that in the absence of any significant past obstetric history or history of surgery, the intraoperative findings of fetus en caul that causes intestinal obstruction following rupture of rudimentary horn of unicornuate uterus presented an interesting clinical situation.