Third trimester abdominal pregnancy presenting as partial small bowel obstruction in a resource-limited setting: a case report.

BACKGROUND: Abdominal pregnancy is a rare and potentially life-threatening form of ectopic gestation in which the embryo implants within the peritoneal cavity. Diagnosis is often delayed, especially in low-resource settings, owing to limited access to early imaging and nonspecific clinical signs. While gastrointestinal symptoms may occur, intestinal obstruction is an extremely rare presentation of abdominal pregnancy.

CASE PRESENTATION: We report the case of an 18-year-old African Black primigravida who presented to our facility at approximately 30 weeks' gestation with decreased fetal movements and dull abdominal pain. She had been managed at a peripheral health center 1 week earlier for presumed partial small bowel obstruction. On admission, examination revealed a fundal height larger than expected and a breech fetus with no cardiac activity on ultrasound. A visible endometrial stripe and a pelvic mass containing the fetus raised suspicion for an extrauterine pregnancy. Laparotomy confirmed a third-trimester abdominal pregnancy with intra-abdominal fetal demise. The fetus was free in the peritoneal cavity, and the placenta was attached to the omentum and small bowel. The placenta was successfully removed after careful dissection and partial omentectomy. The patient recovered well postoperatively and was discharged in stable condition.

CONCLUSION: This case highlights the diagnostic complexity of abdominal pregnancy in low-resource environments, especially when presenting with atypical gastrointestinal symptoms. It underscores the importance of high clinical suspicion, detailed ultrasonographic assessment, and multidisciplinary preparedness in achieving favorable maternal outcomes. Early recognition and appropriate surgical intervention remain key to reducing morbidity and mortality in these rare but high-risk pregnancies.