Successful Surgical Management of an Advanced Abdominal Pregnancy in a Resource-Limited Setting

Abdominal pregnancy (AP) is a rare ectopic pregnancy (EP), often misdiagnosed, with no standardized treatment due to limited literature. Most APs result in early pregnancy loss, making advanced AP cases even rarer. We present a case of advanced AP in a limited resource setting.

A 23-year-old woman with a previous cesarean delivery presented with a 2-month history of amenorrhea, chest pain, and lower abdominal pain. Despite a positive pregnancy test, pelvic ultrasound showed no intrauterine or EP but revealed a paracecal mass, raising suspicion of an appendiceal abscess. Because of financial constraints, no further diagnostic investigations were performed, and urgent exploratory laparotomy was undertaken. Surgery revealed abortive material, including fetal bone fragments consistent with a 21-23-week pregnancy. Ischemic placental tissue infiltrated the serosa and deeper layers of the cecum and distal ileum, with active bleeding, deperitonealization, and partial bowel obstruction. An ileocecal resection with ileocolic anastomosis was therefore performed. Recovery was uneventful, with no complications at 30-day and 18-month follow-up.

High clinical suspicion for AP is crucial, especially in cases with inconclusive imaging. A tailored surgical approach to manage placental invasion can lead to positive outcomes even in complex cases of advanced AP.