Uterine leiomyomas are very common tumors found in women. Rupture of a uterine leiomyoma is an unusual source of hemoperitoneum. This is a case report of such. A 28-year-old woman presented to the emergency department with acute onset of abdominal pain after a bowel movement and who had a history of fibroids. The patient was stable and went for a formal ultrasound, which showed a large fibroid and free fluid in the peritoneum. She had a laparotomy, and an actively bleeding fibroid surface vein was found. The patient required transfusion of 2 U of packed red blood cells, and a myomectomy was performed, with an uneventful postoperative course. Because surgical intervention is the only definitive treatment, emergency physicians should be aware of this rare complication.