Ovarian Ectopic Pregnancy: A Rare Case Report in a Resource-Limited Setting
Abstract
A rare ovarian ectopic pregnancy highlighting diagnostic and management challenges in a resource-limited setting.
Ovarian ectopic pregnancy is a rare form of ectopic pregnancy in which a fertilized ovum implants within the ovary. Intrauterine contraceptive device use is reported as an important risk factor, and management may be conservative or surgical.
The report describes a 32-year-old Gravida 2 Para 0010 with a previous right ectopic pregnancy that had been successfully managed medically two years earlier. She presented with severe right lower abdominal pain and eight weeks of amenorrhoea.
The urine pregnancy test was positive. Pelvic ultrasound demonstrated an empty uterus and findings initially suggestive of an unruptured tubal ectopic pregnancy, together with an unruptured right ovarian cyst. Quantitative serum β-hCG, transvaginal ultrasonography and laparoscopy were unavailable in the clinical setting.
Because of severe right lower abdominal pain and diagnostic uncertainty, emergency laparotomy was performed. The fallopian tubes were found to be normal, while a right fluid-filled ovarian mass was identified and removed by ovarian wedge resection.
Ovarian ectopic pregnancy should be considered in reproductive-age women presenting with severe acute abdominal pain and a positive pregnancy test, including when ultrasound findings are inconclusive, particularly in resource-limited settings where quantitative serum β-hCG testing and laparoscopy may not be available.
Gravida 2 Para 0010.
Presented with severe right lower abdominal pain.
Emergency open surgical exploration was undertaken.
Ovarian mass removed while preserving the remaining ovary.
Prior Ectopic Pregnancy
The patient had a history of right ectopic pregnancy two years earlier, which had been successfully managed medically.
Severe Right-Sided Abdominal Pain
She presented with severe continuous right lower abdominal pain and eight weeks of amenorrhoea. There was no vaginal bleeding or vaginal discharge, and one episode of vomiting was reported.
Haemodynamically Stable
Blood pressure was 105/66 mmHg and pulse was 87 beats per minute. The abdomen was not distended, with tenderness over the hypogastrium and right iliac fossa and no rebound tenderness.
Positive Qualitative β-hCG
Urine pregnancy testing was positive. Quantitative serum β-hCG testing was not available in the clinical setting, limiting the ability to use serial quantitative measurements for diagnosis and follow-up.
Initial Diagnostic Uncertainty
Pelvic ultrasonography demonstrated an empty uterus, findings interpreted as an unruptured ampullary ectopic pregnancy, free fluid in the pouch of Douglas and an unruptured right ovarian cyst of approximately 30 ml.
Limited Diagnostic Modalities
Transvaginal ultrasound, quantitative serum β-hCG testing and laparoscopy were unavailable, contributing to the diagnostic and management challenges described in the report.
Right Ovarian Pregnancy
Emergency laparotomy demonstrated a non-gravid uterus and normal fallopian tubes. A fluid-filled mass was identified within the right ovary. On sectioning, an encapsulated non-living fetus of approximately nine weeks was identified with surrounding clear amniotic fluid.
Ovarian Wedge Resection
The ovarian ectopic pregnancy was removed by wedge resection, with preservation of the remaining ovarian tissue.
Five-Day Admission
The patient remained in hospital for five days and received intravenous antibiotics and analgesia. No postoperative complications were reported.
Further Reproductive Care
At one month after discharge, investigations for sexually transmitted infections were requested to evaluate possible pelvic inflammatory disease. The patient was subsequently referred to a gynaecologist for follow-up and preparation for a future pregnancy.
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Clinical Case Report
This publication reports a rare ovarian ectopic pregnancy and highlights the diagnostic and management challenges encountered in a resource-limited clinical setting.
Resource-Limited Healthcare
The report describes management in a setting where quantitative serum β-hCG measurement, transvaginal ultrasonography and laparoscopic facilities were unavailable.
32-Year-Old G2P0010
The patient presented with eight weeks of amenorrhoea and severe right lower abdominal pain, with a previous history of medically managed right ectopic pregnancy.
Ovarian vs Tubal Ectopic Pregnancy
Initial pelvic ultrasonography suggested an unruptured ampullary ectopic pregnancy together with a right ovarian cyst. Operative exploration subsequently demonstrated normal fallopian tubes and an ovarian pregnancy.
Emergency Laparotomy
Because of severe abdominal pain, diagnostic uncertainty and the lack of laparoscopic facilities, emergency laparotomy was selected for surgical management.
Ovarian Wedge Resection
The ovarian ectopic pregnancy was removed by wedge resection while preserving the remaining ovarian tissue.
No Reported Complications
The patient was hospitalised for five days and received intravenous antibiotics and analgesics. No postoperative complications were reported.
Consent Documented
The published manuscript states that a patient consent form was provided separately and included the patient’s signature and agreement to publication of the case report.
CRediT Contributor Roles
Concept and Design:
Sankara Nykam, Tchinda Dimitri and Fotio Theophile.
Acquisition and Interpretation of Data:
Steve Kouam and Nges Samuel.
Drafting of Manuscript:
Sankara Nykam and Tchinda Dimitri.
Manuscript Review:
Tatapong Lily Funzeh and Ma-Fese Dorcas Akwo.
Supervision:
Fotio Theophile.
No Conflict Declared
The authors declare that the work was conducted in the absence of commercial or financial relationships that could be construed as a potential conflict of interest.
No Financial Support
The authors declared that no financial support was received from any organisation for the submitted work.
Editorial Timeline
CC BY 4.0
This article is published by The Operating Room Global
Journal under the Creative Commons Attribution 4.0
International licence.
DOI: 10.64573/torgj2512003
Volume 2 · Issue 1 · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Article DOI: 10.64573/torgj2512003.
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