Article

Twin lithopaedions: a rare entity

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Abstract

Lithopaedion (stone baby) is the name given to an extrauterine pregnancy that evolves to foetal death and calcification. There are around 300 cases reported in the world medical literature to date. We report the case of a 40-year-old woman who presented with features of acute intestinal obstruction (abdominal distention, vomiting and absolute constipation) for a week. She had a past history of a missed abortion in the fifth month of gestation, eight years prior to this presentation, one which we thought to be irrelevant to the present illness. However, complementary investigations, including scout abdominal radiographs and ultrasonography of the abdomen and pelvis, were done before the operation. The abdominal radiograph showed two opaque globular masses on either side of the lower abdomen with distended small intestinal loops. Exploratory laparotomy was performed and a portion of strangulated small bowel attached to a solid globular mass behind the left ovary was removed, with a subsequent resection of the gut and end-to-end anastomosis. Upon removal of a thick membrane from the globular mass, a dead five-month-old calcified foetus was recovered. In the right iliac fossa, a similar mass was removed and another dead calcified foetus of similar age was recovered.

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... Put in perspective, abdominal pregnancy incidence is about one in 11,000 pregnancies. Most cases involve singleton foetuses but twin lithopaedions have also been reported [1], [2]. ...
... When symptomatic, lithopaedion is known to cause compression and rupture of adjacent viscera, intestinal obstruction as well as obstructed labour [6], [7]. It is often discovered accidentally during clinical examination, radiologic investigation, or at autopsy [1], [8]. Some cases have been discovered nearly sixty years after foetal demise [4], [5]. ...
... Lithopaidion is generally a single obstetric phenomenon; the literature includes 1 report of twins with lithopaidion [34] and a case of lithopaidion in twins [41] , 1 case of lithopaidion with a coexistent live abdominal ectopic pregnancy [35] , a case of lithopaidion formation after a cervical pregnancy [42] , a case of lithopaidion evolving from hepatic pregnancy [43] , 1 case with a coexistent placental site trophoblastic tumor that was discovered upon the removal of the lithopaidion (after a colostomy for rectal perforation was performed) [33] , and 2 cases with coexistent cervical neoplasm [1,44] ( table 3 ). ...
... Lithopaidion can cause bowel obstruction in rare cases; in 1953, Glass and Abramson [48] reported the occurrence of volvulus of the cecum due to a lithopaidion, and Zaheer [49] (in 1971) and recently Allodé et al. [64] showed a small bowel obstruction due to the same cause. Mishra et al. [34] reported a case with features of intestinal obstruction. Jain and Eckert [30] reported a lithopaidion-like pelvic abscess, while Leke et al. [50] reported a case of obstructed labor in a term pregnancy caused by cephalopelvic disproportion as a result of a lithopaidion retained in a sacculus of the lower uterine segment. ...
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Abdominal pregnancy is an exceedingly rare occurrence, but even more unusual is prolonged retention of an advanced abdominal pregnancy with lithopedion formation. We present the case of prolonged retention of an advanced abdominal pregnancy in an elderly women. A 67-year-old, white woman presented to the emergency department with abdominal pain. An acute abdominal series revealed a fetal skeleton extending from the patient's pelvis to her lower costal margins. Pelvic examination revealed a normal postmenopausal uterus, and human chorionic gonadotropin was negative. On further questioning the patient reported that she had become pregnant 37 years earlier and was diagnosed as having a "missed" pregnancy. She refused intervention at that time but suffered no untoward consequences. She reported having had later a healthy intrauterine pregnancy, delivered vaginally at term. No attempt was made to remove the prior missed abdominal pregnancy. The acute pain episode resolved, and there was no surgical intervention. Abdominal pregnancies can have a complex course, and management decisions can be difficult. This case presents an unusual outcome of an advanced abdominal pregnancy and illustrates a unique approach to management.
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Context: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. Case report: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.
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An 80-year-old Black, South African woman presented in the outpatient department with severe abdominal pain. Ultrasound examination revealed a large echogenic mass (20 x 20 cm) in the right upper quadrant. An abdominal x-ray demonstrated the skeleton of a fully developed extrauterine fetus. It is presumed from the patient's history that this fetus was present for at least 40 years. Radiography revealed a fetus shrouded in a mantle of calcification. The fetus was hyper-flexed with other signs of "intrauterine" death. Fetal dentition charts dated the fetus at 34 weeks, the epiphyses being obscured by extensive calcification. In addition to subcutaneous calcification there was extensive visceral and intracranial calcification.
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We describe an unusual case of extrauterine placental site trophoblastic tumour located in pouch of Douglas in association with a lithopedion. A 35-year-old female presented with acute abdomen and peritonitis following rectal perforation. The patient gave a history of 5 months amenorrhoea followed by vaginal bleeding 5 years prior to admission. At laparotomy, a lithopedion was found in pouch of Douglas with rectal perforation and peritonitis. The lithopedion was removed, rectal perforation was sutured and a colostomy was performed. The colostomy was closed later and tumour was seen in the colostomy wound as well as attached to the lithopedion removed previously. The patient presented with a repeated episode of rectal perforation and the tumour had spread to colon, small intestine, omentum, mesentery and right ovary. A high-grade malignant placental site trophoblastic tumour with aggressive clinical course occurred at an extrauterine site. It complicated calcified abdominal pregnancy and resulted in repeated rectal perforation and peritonitis.
Lithopaedion: stone baby. {online} EURORAD (Case 2439) 2003. Available at: www
  • Ek Alymlahi
  • L Chat
  • M Chellaoui
  • R Dafiri
Alymlahi EK, Chat L, Chellaoui M, Dafiri R. Lithopaedion: stone baby. {online} EURORAD (Case 2439) 2003. Available at: www. eurorad.org/case.php?id=2439. DOI: 10.1594 / EURORAD / CASE 2439. Accessed July 2006.