Aim and objective: Choriocarcinoma can have intricate presentations and pose challenges in management. We are presenting a rare case of spontaneous uterine perforation in a choriocarcinoma. Background: Choriocarcinoma is a rare neoplasm with varied incidence worldwide. It is a highly malignant tumor of trophoblastic tissue. Case description: We present a case of 29-year-old multiparous women admitted with fever and foul-smelling vaginal discharge. After 2 days of admission, she developed features of perforation peritonitis. She was taken up for emergency laparotomy. Hysterectomy was performed in view of perforation of uterus with extensive necrosis. Peritoneal cavity was filled with pus. The histopathological examination revealed choriocarcinoma. Her serum beta-human chorionic gonadotropin (hCG) was 2397 mIU/mL. She received multiagent chemotherapy (EMA/CO) for six cycles till the beta-hCG values came to normal. On 1 year follow-up, the beta-hCG values remained normal. Conclusion: Choriocarcinoma presenting with acute abdomen and pyoperitoneum is a rare clinical presentation and should be a kept as a diagnosis of exclusion. Clinical significance: Timely diagnosis and management can improve the clinical prognosis of the patients.