Uterine sarcomas are rare but very aggressive gynecologic malignancies. The most frequent signs and symptoms at the moment of diagnosis include abnormal uterine bleeding or diffuse abdomino-pelvic pains while acute abdomen by uterine rupture is an uncommon situation. We present the case of a 72 year old patient who presented in emergency for diffuse abdominal pain and hypotension. An emergency laparotomy was performed and a ruptured uterine tumor with small bowel and sigmoidian serosal invasion and intra-peritoneal bleeding was found. The tumor was resected en bloc with total hysterectomy, bilateral adnexectomy, segmental enterectomy and sigmoidectomy, pelvic and para-aortic lymph node dissection. The histopathological and immunohistochemistry examination revealed a poorly differentiated sarcoma. Although it is a rare condition, a uterine sarcoma can rupture and cause hemoperitoneum; emergency surgery while respecting oncologic principles of complete resection is mandatory.