Background: The challenge in the diagnosis of giant ovarian cysts (GOC) is a delicate situation for low and middle-income countries where the resources are very limited. GOC have become rare nowadays as they are diagnosed and managed early due to the availability of good imaging modalities. The purpose of this case report is to show how a huge cystic ovarian mass can mislead the diagnosis of multiple pregnancies, ascites, and intestinal tuberculosis in a woman during reproductive age in low-resource countries. The factors associated with the late presentation of giant ovarian cysts in sub-Saharan Africa is also discussed. Case presentation: The authors present the case of a 36-year-old women, para 4, that was referred to our health center with a grossly distended abdomen wrongly diagnosed as either multiple pregnancy, massive ascites, or intestinal tuberculosis. She was reviewed in different health care facilities without accurate diagnosis. The abdominopelvic ultrasound scan revealed a giant left ovarian cyst. She underwent an exploratory laparotomy where the giant cyst was excised successfully with an uneventful postoperative condition. Histopathology revealed a mucinous cystadenoma. Conclusion: There are several challenges in accurate and timely diagnosis of GOC in women in reproductive age. Routine abdominal ultrasounds scan use may play a role for guiding to an “early diagnosis“