Introduction. Ovarian ectopic pregnancy is a rare form of ectopic implantation associated with a high risk of rupture and life-threatening intra-abdominal hemorrhage. Preoperative diagnosis remains difficult because of the nonspecific clinical and ultrasonographic findings, especially in cases with atypical presentation. Case presentation. We present the case of a 26-year-old woman with a 3-year history of infertility who presented with epigastric pain and diarrhea in early pregnancy. Transvaginal ultrasonography revealed the absence of an intrauterine gestational sac, a left adnexal mass, and significant hemoperitoneum. Emergency laparoscopy identified a ruptured left ovarian ectopic pregnancy complicated by massive hemoperitoneum of approximately 2400 mL. Partial ovarian resection with removal of trophoblastic tissue and preservation of viable ovarian parenchyma was performed successfully. Conclusions. This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in women of reproductive age presenting with atypical abdominal or gastrointestinal symptoms. Early diagnosis and prompt minimally invasive surgical management are essential for preventing severe maternal morbidity and preserving reproductive potential.