Early diagnosis and successful management of an abdominal ectopic pregnancy in a low-resource setting: a case report

Abdominal pregnancy is a rare but potentially life-threatening form of ectopic pregnancy in which the fertilized ovum implants in the abdominal cavity. This serious obstetric condition often remains undiagnosed until the end of the pregnancy and carries a high risk of massive bleeding and injury to neighboring organs. The diagnostic challenges become even greater in resource-poor settings where limited imaging techniques can delay timely intervention. We describe a 40-year-old gravida 5, para 4, Tigrayan patient who presented with persistent abdominal pain, nausea and vomiting of four months duration. She was repeatedly treated for suspected urinary tract infections. A transvaginal ultrasound revealed an abdominal pregnancy with a viable fetus in the posterior cul-de-sac. The patient underwent an urgent laparotomy to remove a 150 g fetus and an adherent placenta, necessitating a right salpingo-oophorectomy. Despite the high risk of bleeding, the diagnosis was made relatively early given the limited clinical resources, and postoperative recovery was without complications. This case highlights the complexity of diagnosing abdominal ectopic pregnancy, particularly in low-resource settings where imaging and the availability of specialist support are limited. Early identification and coordinated surgical management can significantly reduce morbidity and mortality. Timely clinical suspicion, careful ultrasound examination and multidisciplinary care are critical to improving maternal outcomes in this rare but dangerous obstetric entity.