A 53-year-old woman went into shock with a spontaneous uterine rupture due to choriocarcinoma that occurred 23 years after an elective abortion in the first trimester, and she underwent an emergency hysterectomy. After 4 courses of uneventful postoperative chemotherapy, she suffered from severe pneumonia. Fortunately, however, she recovered and has remained in complete remission at 2.5 years follow-up. This is a case of uterine choriocarcinoma with a spontaneous rupture after the longest latent period yet reported.