Introduction/Background*Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues. The hydatidiform mole is the most common form of GTD, representing 80 percent of cases. An invasive mole is a hydatidiform mole characterized by the enlarged hydropic villi invading into the myometrium, into vascular spaces, or into extrauterine sites.

Methodology Case presentation: Here is a case with invasive mole after the evacuation of complete molar pregnancy, presented with an acute abdomen. We desired to preserve the uterine because our 21 years old patient doesn’t have a child.

Clinical Discussion An emergency abdominal ultrasound scan showed a 47*34*55 mm ill-defined hyperechoic heterogeneous mass with anechoic cystic vascular spaces within it, in the posterior wall of the uterus away from the endometrium that extended to the serous layer of the uterus. Laparotomy was done. After the evacuation of 2 L of hemoperitoneum, an approximately 5×4 metastatic, vesicular mass was seen in the posterior wall of the uterus, which was resected and uterine preservation was successful.

Conclusion*This case report describes the clinical, imaging, surgical and histopathological findings of Invasive mole after a hydatidiform molar pregnancy. Our case highlights the feasibility of fertility-preserving surgery in the case who experienced life-threatening hemorrhage due to a ruptured uterus.