Abstract
This case report discusses the rare and complex occurrence of an advanced abdominal pregnancy in a 36-year-old multiparous woman at 26 weeks of gestation, compounded by chronic pelvic inflammatory disease and Fitz-Hugh-Curtis syndrome. The patient was presented with severe symptoms, including abdominal pain, fever, chills, constipation, and vaginal spotting, leading to her hospital admission. Diagnosis was challenging due to the advanced stage of the pregnancy and its abdominal location, particularly in the Douglas pouch, as detected through ultrasonography. According to anatomical standards, this is an intraperitoneal pregnancy rather than an intra-abdominal pregnancy because the fetus developed in the peritoneal cavity. This case is significant for illustrating the critical need for high clinical suspicion and skilled sonographic evaluation to identify such advanced abdominal pregnancies. The successful management of this case through laparotomy, despite the complexities of concurrent conditions, emphasizes the possibility of safe placental removal without increased hemorrhage risk. This report highlights the importance of awareness and expertise in handling rare presentations of ectopic pregnancies, underscoring the potential for positive outcomes with appropriate surgical intervention.