Case Report: Laparoscopic management of a primary omental pregnancy concealed beneath the bowel

Primary omental pregnancy is an extremely rare form of ectopic pregnancy. We report a case of successful laparoscopic management in a 19-year-old nulliparous woman with no traditional risk factors. Despite sonographic evaluation, including transvaginal, transabdominal, and multi-organ abdominal ultrasonography, the ectopic lesion was not identified preoperatively. Diagnostic laparoscopy was performed, but initial pelvic exploration was also negative. Only after lifting the bowel was a 2 cm omental pregnancy discovered, concealed beneath the bowel, and completely excised. Postoperatively, serum beta-human chorionic gonadotropin (β-hCG) declined by 70.3% on day 1 and 95.3% on day 4 without methotrexate use. This case underscores two points: first, systematic laparoscopic exploration beyond the pelvis is essential when initial inspection is negative; second, the absence of traditional risk factors does not exclude rare-site ectopic implantation.