Neglected intrauterine fetal demise for more than two decades leading to the development of a lithopedion: a case report

Abstract

BackgroundLithopedion is a word derived from the Greek words lithos, meaning stone, and paidion, meaning child, to describe a fetus that has become stony or petrified. Lithopedion is a rare complication of pregnancy which occurs when a fetus dies and becomes too large to be reabsorbed by the body. This entity in rare circumstances can be challenging for physicians to diagnose since it has a range of clinical manifestations.Case presentationWe present a case of a 55-year-old, gravida IV para III, Ethiopian woman from Ethiopia with a retained fetus and vesicovaginal fistula after an obstructed labor and a neglected intrauterine fetal demise of approximately 22 years. The diagnosis was confirmed by suggestive clinical history, physical examination findings, and an abdominopelvic computed tomography scan. Laparotomy and removal of the lithopedion was done and our patient was sent to a fistula hospital for vesicovaginal fistula repair.ConclusionThis case is a rare phenomenon in which the dead fetus remained in the uterus for a long time after a neglected obstructed labor and uterine rupture.

A Lithopedion – An Unusual Calcified Abdominal Pregnancy: A Case Report

“…It may be caused by a primary intraabdominal pregnancy or a secondary intraabdominal pregnancy resulting from a ruptured intrauterine or tubal pregnancy (1,5,9). A history of ectopic pregnancy, pelvic inflammatory disease, tubal surgery, congenital and acquired uterine anomalies, and endometriosis are among the risk factors associated with abdominal pregnancy (4,6). This patient's history of multiple spontaneous miscarriages, which may be complicated by subclinical infection, was identified as a risk factor.…”

“…As a result of abnormal placental attachment to extrauterine structures, including large vessels, there is a high risk of catastrophic bleeding. In a review of 225 case reports, the mean blood loss ranged from 50 to 7,500 mL, and 25% of patients required blood transfusions (6,8,10). In this case, the obstetrician had scheduled surgery for the patient, but the patient refused and never arrived at the hospital.…”

“…Consequently, the majority are not diagnosed until they develop complications. However, this is dependent on the gestational age at delivery (4,6,10).…”

“…The Greek word lithopedion comprises litho (stone) and pedion (infant). Lithopedion is an abdominal pregnancy in which the fetus expires, calcifies, and grows too large to be reabsorbed by the mother's body (1,3,6). The incidence of abdominal pregnancy is 1:11,000 pregnancies, accounting for 1.5-2.0% of all ectopic pregnancies; the incidence of lithopedion is 1.5-1.8% of abdominal pregnancies.…”

Old uterine ruptures you need to know about

“…В 2019 году в Journal of Medical Case Reports Fitsum Fikru Gebresenbet и соавт. опубликовали статью с описанием случая из Эфиопии с «беременностью», длившейся более 20 лет, и везиковагинальным свищом, возникшим вследствие осложненных родов [3].…”