Dead fetus in uterus for 20 years, develops into lithopedion: Rare phenomenon

Dr Fitsum Fikru Gebresenbet at Department of Radiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia and colleagues have reported a rare case of lithopedion. This case is a rare phenomenon in which the dead fetus remained in the uterus for a long time after a neglected obstructed labour and uterine rupture. The case has appeared in the Journal of Medical Case Reports.

Lithopedion 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

Our patient is a 55-year-old Ethiopian woman, gravida IV para III abortion 0, who gave birth to three children at home by spontaneous vaginal delivery. She presented to our hospital claiming she was carrying a dead fetus in her womb from a pregnancy that had been there for 22 years. The pregnancy lasted up to nine months uneventfully at which time the membrane ruptured and she went into labour. After 3 days of labour at home, she developed vaginal bleeding and visited a nearby hospital where she was informed that she had a uterine rupture which had to be operated on. However, she refused the surgery and went home. Over time she developed urinary incontinence.

She lost all her three children from an unspecified medical illness before their first birthday, although she claimed all the pregnancies and the labour were uneventful. Since the incident, she is divorced and lives alone supported by her sister.

At her current presentation, she had lower abdominal pain which had increased in severity, vaginal discharge, and urine per vagina since the onset of the condition. She had no other known medical illness.

On physical examination, there was a gravid uterus of 20-week size and a non-tender, fixed, and firm abdominopelvic mass with no signs of fluid collection in her peritoneal cavity. There was a continuous leakage of urine through her vagina but a leak point was unidentified. Her vaginal canal was filled with a 4 cm by 5 cm, oval and stony hard mass.

Laboratory findings, complete blood count, and organ function tests were in the normal range. An abdominal ultrasound was difficult to perform as there was only shadowing in her pelvis from the bony structures and our patient was incontinent, therefore, she was unable to retain urine.

Abdominopelvic computed tomography (CT) findings: On the scanogram, multiple calcified tubular fetal parts were demonstrated in the pelvis of our patient. On the post-contrast images, the uterus was enlarged and the fundus extended up to the level of the umbilicus. Well-formed tubular bony parts were detected within the uterine cavity which had compressed and displaced the bladder. A diffuse pelvic and lower abdomen inflammation and focal adhesion of the uterus to the abdominal wall were additionally noted.