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Lithopedion (Stone Baby)

1996; King Faisal Specialist Hospital and Research Centre; Volume: 16; Issue: 1 Linguagem: Inglês

10.5144/0256-4947.1996.69

0975-4466

Mahmood Moshiri, Ali Salari, Hamid Reza Mansorian, Robabeh Shariat,

Porphyrin Metabolism and Disorders

Case ReportsLithopedion (Stone Baby) Mahmood Moshiri, BS, MS, MD, CPath, FICN Ali Akbar Salari, MD Hamid Reza Mansorian, and MD Robabeh ShariatMD Mahmood Moshiri Address reprint requests and correspondence to Dr. Moshiri: Division of Pathology, Martyr Rajaie Cardiovascular Medical Centre, Vali Asr Avenue, Tehran 19974, Iran. From the Department of Pathology (Dr. Moshiri), Yazd Shahid Sadoughi University of Medical Sciences, Yazd Search for more papers by this author , Ali Akbar Salari From the Department of Surgery, Yazd Shahid Sadoughi University of Medical Sciences, Yazd Search for more papers by this author , Hamid Reza Mansorian From the Department of Radiology, Yazd Shahid Sadoughi University of Medical Sciences, Yazd Search for more papers by this author , and Robabeh Shariat From the Department of Radiology, Yazd Shahid Sadoughi University of Medical Sciences, Yazd Search for more papers by this author Published Online:1 Jan 1996https://doi.org/10.5144/0256-4947.1996.69SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionIn a case of lithopedion, the fetus survived to 21 weeks' gestation. The mother had become pregnant and had had an incomplete abortion. Forty-four years later, a careful physical examination disclosed the presence of a pelvic mass of 21 weeks' size that extended into the lower abdomen. The patient denied previous knowledge of the discovered mass. The calcified fetus and investing membranes were identified on a plain film of the abdomen and constitute an absolute sign of lithopedion.The word “lithopedion” (from the Greek lithos meaning stone, plus paidion, meaning child) describes a dead extrauterine fetus that has become calcified. Most cases (as in our case) have been discovered incidentally at the time of surgery, necropsy or roentgenograms of the abdomen or pelvis.Lithopedion is a rare obstetric occurrence. Its incidence is difficult to calculate, since many cases are either unrecognized or undiagnosed.In the 16 case reports in the world literature since 1966 (12 in English), five of the patients were over 65 years of age. In these 12 English case reports, features were retained 1.5 to 35 years, with seven retained 15 years or longer.Case reports of lithopedion were more common in the first half of the century and today are more common in underdeveloped and developing countries. A plausible explanation for this change is current early diagnosis of ectopic gestation.CASE REPORTAn 85-year-old female, gravida 5, para 4, with chronic cholecystitis, was hospitalized because of severe right upper quadrant pain. Physical examination disclosed the presence of a 21-week pelvic mass that extended into the lower abdomen. The patient denied previous knowledge of the mass.Two years after her fourth delivery, her menstrual history changed, her menstrual periods became irregular and intermittent (as she can barely remember). Menopause occurred at the age of 44 years (41 years prior to admission).Intravenous cholangiography revealed multiple stones in the gallbladder with thickening of the wall. Laparotomy was performed and the patient underwent cholecystectomy. Ovaries, fallopian tubes and uterus were unremarkable. A stony mass on the posterior of the broad ligament was found to contain a lithopedion. The diagnosis was apparent after identifying two fetal femurs, skull, fingers, vertebrae and bony thorax. Upon reviewing her previous history, it was discovered that she had lived 44 years in her village without any serious medical complaints, especially no abdominal discomfort.DISCUSSIONOur case represents a classic example of lithopedion, an entity described as early as the 10th century by Albucasis (936 to 1013 AD), a surgeon of the Arabic era of medicine.1,2 The first detailed description of lithopedion formation dates to 1888, when Kuchenmeister noted that calcification may involve the fetus, membranes, placenta or any combination of these structures.3,4 Kuchenmeister classified lithopedion as: 1) Lithokelyphos (stone sheath or eggshell), in which the membranes alone are calcified. 2) Lithokelyphopedion (stone sheath child), in which both the membranes and fetus are calcified. 3) True lithopedion (stone baby), in which the fetus is infiltrated by calcium salts and membrane calcification is negligible.3,5,6,10 Conditions necessary for the development of a lithopedion are the following: 1) Extrauterine pregnancy by virtue of uterine rupture, missed tubal abortion, ovarian pregnancy or abdominal pregnancy. 2) The fetus must survive more than three months. A shorter survival time results in absorption of the fetus. 3) The ectopic pregnancy must escape medical detection. 4) The fetus must remain sterile. 5) The necessary condition for calcium deposition must be present.7,8,10 Tien reported some statistical data on lithopedions. At the time of death, 20% of the fetuses in the cases he discussed had lived from three to six months, 28% between seven and eight months, and 43% between nine months and term.12 The maternal age at diagnosis in 27% of the cases was 23 to 35 years, and in 63% of the cases, it was 45 to 100.12 In 60% of the cases, the lithopedion was retained for four to 20 years and in 40%, 25 to 50 years.12 The dead fetus becomes dehydrated and infiltrated with calcium salts. Sometimes the placenta is calcified, too.10Most of the lithopedions remain asymptomatic inside the abdominal cavity; however, there are reports of extrusion of fetal parts through body orifices, including mouth, abdominal wall, intestine and rectum. Surgical removal should be undertaken once the diagnosis is made.6Fagan nicely demonstrated roentgenographic and CT appearances in 1980 and showed how they aid in the diagnosis.10 However, the calcified fetus is best identified on a plain film of the abdomen.10,13,14 The differential diagnosis includes calcified pelvic and abdominal mass, teratoma of the ovary, calcified leiomyoma of the uterus and calcification of the epiploic appendages.3,10Most of the lithopedions remain asymptomatic, although complications such as volvulus have been reported.10 Surgical removal of any dead abdominal fetus or lithopedion as soon as the diagnosis has been established is warranted.6Figure 1. Calcified fetus with details of radiographic findings.Download FigureARTICLE REFERENCES:King G. "Advanced extrauterine pregnancy" . Am J Obstet Gynecol. 1954; 67:712–40. Google ScholarAlbucasis: De Chirurgia Arabia et Latine Tomus Primus. Cura Johannis Channing Netu et Civitate. Londinensis, Oxonii: E Typographeo Clarendoniano, 1778. Google ScholarBrandman L. "True lithopedion: incidental finding at necropsy and review of the literature" . Am J Obstet Gynecol. 1947; 54:887–9. Google ScholarKuchenmeister F. "Uber Lithopedion" . Arch Gynak. 1881; 17:153–259. Google ScholarD'Aronoy R, King EL. "Lithopedion formation in extrauterine fetal masses" . Am J Obstet Gynecol. 1992; 3:377–84. Google ScholarClark JFJ, Jones SA. "Advanced ectopic pregnancy" . J Reprod Med. 1975; 14:30–3. Google ScholarMalhieu A. "Lithopedion developed from extrauterine gestation in intrauterine and extrauterine pregnancy" . Am J Obstet Gynecol. 1929; 37:297–302. Google ScholarOden PW, Lee HC. "Lithopedion with calcified placenta case report" . Va Med. 1940; 67:304–6. Google ScholarHemley SD, Schwinger A. "Lithopedion: case report and survey" . Radiol. 1952; 58:235–8. Google ScholarFagan CJ. "Lithopedion, stone baby" . Arch Surg. 1980; 115:764–6. Google ScholarShah-hoseini R, Edvard JR. "Lithopedion: a case report" . J Reproduct Med. 1987; 32:131–3. Google ScholarTien D. "Lithopedion: general discussion and case report" . Chin Med J. 1949; 67:451. Google ScholarSante LR, Emmert F. "Life history of lithopedion" . AJR. 1932; 27:202–3. Google ScholarWoodberry JM, Jarrett JC. "Abdominal lithopedion retained for 13 years: case report with review" . Am J Obstet Gynecol. 1960; 80:590–5. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 16, Issue 1January 1996 Metrics History Accepted20 March 1995Published online1 January 1996 ACKNOWLEDGMENTSThe authors acknowledge the useful suggestions of Dr. Sadar Arhami. We are grateful to Mr. Hosein Amirarjumand, Mr. Soflaei and Mr. Mohsen Rakhsha.InformationCopyright © 1996, Annals of Saudi MedicinePDF download