When Pregnancy Defies Anatomy, Beyond Conventional Reproductive Pathways: A Case Series of Two Rare Ectopic Pregnancies in Anatomically Disconnected Reproductive Structures and Review of Transperitoneal Gamete Migration

Introduction Ectopic pregnancy typically occurs through established reproductive pathways involving functional tubal transport. However, rare cases occur despite congenital or acquired disruption of reproductive tract continuity. Methods We present two rare cases of ectopic pregnancy occurring despite apparent anatomical barriers to conception. A structured literature review identified published reports of pregnancy or ectopic pregnancy occurring despite congenital or acquired disruption of reproductive tract continuity. Institutional ethics approval and informed consent was obtained. Results First case involved 24 year old nulligravid woman with infertility, a non-communicating right rudimentary horn associated tubal ectopic pregnancy. Laparoscopy confirmed absence communication between rudimentary horn and uterine cavity, while a haemorrhagic corpus luteum cyst was identified in the contralateral ovary. Second case involved a 28 year old woman with a history of right ectopic pregnancy treated by partial salpingectomy. Postoperative hysterosalpingography demonstrated patent left fallopian tube and no contrast spillage into right adnexa. During a subsequent pregnancy, ultrasonography revealed a viable extrauterine gestation within right adnexal. Laparoscopy confirmed recurrent right sided ectopic pregnancy, and completion salpingectomy was performed. Literature review identified 13 publications, predominantly case reports and small case series, describing ectopic pregnancy despite altered reproductive tract anatomy. Discussion Both cases demonstrate pregnancy occurring despite disruption of conventional reproductive pathway. Reviewed literature demonstrated several proposed mechanisms include transperitoneal migration of spermatozoa, oocytes/embryos, residual tubal patency, and postoperative recanalization. Conclusion Ectopic pregnancy may occur despite congenital or acquired reproductive tract discontinuity. Awareness of uncommon presentations is essential, while these cases further support the existence of alternative reproductive pathways beyond conventional models of gamete transport.