The histopathology of 110 cases of tubal gestation was reviewed. No evidence was found of the development of the gestation into the tubal muscularis and beneath the overlying peritoneum. The localized tubal mass identified clinically was secondary to luminal distention. It was clear that tubal rupture occurred secondary to localized distention and vascular compromise with hemorrhagic necrosis and was not secondary to invading chorionic villi. With conservative linear salpingostomy, the localized tubal damage histologically appeared to be about the same as that seen in spontaneous rupture. Difficulty in controlling bleeding in conservative surgical procedures may well be a reflection of the viability of the villi and implantation of the more vascular, mesenteric side of the tubal lumen.