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Introduction: Congenital uterine anomalies result from abnormal formation, fusion or resorption of mullerian ducts during fetal life. The prevalence is 5.5% in general population of which unicornuate uterus has a prevalence of 10%. This report presents a rare case of ectopic pregnancy implanting in the tubal cornua in a unicornuate uterus in a 30 year old third gravida. Material and Methods: A 30 year old third gravida came with 2 months amenorrhoea, severe abdominal pain and spotting per vaginum in hemodynamically unstable condition following which diagnosis of ruptured ectopic pregnancy was made on USG. Intraoperative findings revealed unicornuate uterus with right sided ruptured interstitial ectopic pregnancy (previously known as cornual ectopic pregnancy). Left sided fallopian tube or uterine horn was not visualized. Exploratory laparotomy was done along with right sided cornual resection and repair. Discussion: Interstitial pregnancy occurring in the uterine horn is a scarcely documented phenomenon in medical literature and poses a formidable threat to maternal health due to the potential for late detection, carrying an associated risk of massive hemorrhage following rupture. Due to the proximity to major vessels, it is associated with a mortality rate as high as 2.5%. Prompt diagnosis using positive pregnancy test, clinical assessment, and ultrasound is necessary to plan the surgical management. Immediate surgical intervention via laparoscopy or laparotomy along with hemodynamic resuscitation is the preferred treatment. Conclusion: This case report underscores the importance of early diagnosis and treatment to reduce the surgical morbidity, mortality and improve the patient outcome. It delves into the complications of uncommon ectopic pregnancy which was further complicated by the presence of unicornuate uterus. In patients desiring fertility preservation, it poses a major surgical challenge and the decision has to be made after outweighing the risk of surgical mortality.