Background: Abdominal ectopic pregnancy (AEP) is a rare and potentially life-threatening obstetric condition which complicates on average 1 in 10000 to 1 in 30000 pregnancies. Its diagnosis is challenging because the presenting symptoms are non-specific and some do not present with symptoms. AEP is associated with enormous complications, including perinatal and maternal morbidity and mortality. The purpose of this report is to highlight a clinically important but rare condition which can pose a diagnostic challenge, especially in regions with limited health resources and poor patient health-seeking behaviour, such as found in Nigeria and other sub-Saharan countries.

Case presentation: We present a 38-years old G7P3+3(3A) with post-dated pregnancy and incidental finding of intraabdominal pregnancy complicated by fetal death during Caesarean section, following failed induction of labour. Intra-operative findings included a female macerated stillborn and a ball-shaped placenta found within the peritoneal cavity. The uterus was intact, about 20 weeks size, with grossly normal fallopian tubes and ovaries bilaterally. Her post-operative recovery was unremarkable.

Discussion: Despite multiple trans-abdominal scans done by this patient, the diagnosis of AEP was missed. This emphasises the need to have a high index of suspicion, coupled with the availability of high frequency ultrasound and skilled sonologists. A sizable number of cases are discovered during abdominal surgeries like elective Caesarean section or Caesarean section for a failed induction of labour. Following diagnosis, interventions should be prompt in order to avert complications that can ensue. This case highlights the complexity in the diagnosis of AEP in a resource constrained region and the need for improved diagnostic infrastructure to help in the timely diagnosis and management of AEP.