A rare case of primary ovarian pregnancy with diagnostic and surgical challenges: a case report.

Introduction and importance: Ovarian ectopic pregnancy (OEP) is a rare but serious condition, accounting for only 0.5-3% of all ectopic pregnancies. Because it is so uncommon and its symptoms often mimic other conditions, diagnosing OEP can be incredibly difficult. Presentation of case: This case report follows a 24-year-old woman, pregnant for the first time, who arrived at the hospital with abdominal pain and vaginal bleeding. Surprisingly, she had none of the typical risk factors associated with ectopic pregnancies. Initially, her condition was misdiagnosed until an ultrasound revealed a gestational sac in her adnexa. She underwent emergency laparotomy, which confirmed a ruptured OEP. Surgeons performed an ovarian wedge resection, and the diagnosis was later confirmed by histopathology. Clinical discussion: This case highlights how crucial early detection and surgical intervention are in OEP, especially in settings with limited medical resources. It also reinforces that any woman of reproductive age with sudden abdominal pain and bleeding should be evaluated for OEP, even if she has no known risk factors. Conclusion: Timely treatment and histopathological verification are essential to prevent complications and protect future fertility. This case also highlights the need for heightened awareness, rapid imaging, and decisive surgical action even when symptoms do not follow the usual pattern. Given that few documented cases exist, particularly in low-resource environments, this report adds valuable insights into the diagnosis and management of OEP.