Ovarian Ectopic Pregnancy: A Case Report of Two Cases Highlighting Diagnostic and Management Challenges

Ovarian ectopic pregnancy (OEP) is a rare but potentially life-threatening form of ectopic gestation. Although recognized as a distinct clinical entity, its pathophysiology, diagnosis, and management remain poorly defined. Clinical presentation is often nonspecific and may mimic acute pelvic pathologies such as ruptured corpus luteum, hemorrhagic ovarian cysts, or miscarriage in women presenting with vaginal bleeding. In some cases, it resembles a pregnancy of unknown location (PUL) when the gestation cannot be localized on imaging, complicating preoperative diagnosis. Prompt recognition is critical to avoid severe hemorrhagic complications, and laparoscopy remains the mainstay of both diagnosis and treatment. We describe two cases with distinct clinical presentations: one involving a 34-year-old multiparous woman presenting with acute pelvic pain, vaginal bleeding, hemoperitoneum, and a hemorrhagic right ovarian lesion confirmed histologically as OEP, and another a 17-year-old nulliparous woman initially managed as a PUL who later presented with syncope, nausea, and vomiting, where laparoscopy revealed a bleeding ovarian mass, which is also confirmed histologically as OEP. OEP should be considered in reproductive-aged women presenting with acute abdominal pain, hemoperitoneum, and elevated beta human chorionic gonadotropin, even when ultrasound findings are inconclusive. These cases emphasize the need for a high index of suspicion and the role of laparoscopy in diagnosis and management. Early surgical intervention reduces morbidity and preserves ovarian function. Given its rarity and the absence of standardized guidelines, appropriate counseling is essential, and larger datasets are needed to inform future diagnostic and management protocols.