Lithopedion

A lithopedion. This highly unusual specimen remained in the abdomen of a woman for 55 years. During this time the mother had five additional uncomplicated pregnancies.

A lithopedion – also spelled lithopaedion or lithopædion – (Ancient Greek: λίθος = stone; Ancient Greek: παιδίον = small child, infant), or stone baby, is a rare phenomenon which occurs most commonly when a fetus dies during an abdominal pregnancy,[1] is too large to be reabsorbed by the body, and calcifies on the outside as part of a maternal foreign body reaction, shielding the mother's body from the dead tissue of the fetus and preventing infection.

Lithopedia may occur from 14 weeks gestation to full term. It is not unusual for a stone baby to remain undiagnosed for decades, and it is often not until a patient is examined for other conditions or a proper examination is conducted that includes an X-ray, that a stone baby is found.

The condition was first described in a treatise by the physician Abū al-Qāsim (Abulcasis) in the 10th century, but fewer than 300 cases have been noted in 400 years of medical literature. The earliest lithopedion is one found in an archaeological excavation at Bering Sinkhole, on the Edwards Plateau in Kerr County, Texas dated to 1100 BC.[2] Another early example was found in a Gallo-Roman archaeological site in Costebelle, southern France, dating to the 4th century.[3]

In 1880, German physician Friedrich Küchenmeister reviewed 47 cases of lithopedia from the medical literature and identified three subgroups: Lithokelyphos ("Stone Sheath"), where calcification occurs on the placental membrane and not the fetus; Lithotecnon ("Stone Child") or "true" lithopedion, where the fetus itself is calcified after entering the abdominal cavity, following the rupture of the placental and ovarian membranes; and Lithokelyphopedion ("Stone Sheath [and] Child"), where both fetus and sac are calcified. Lithopedia can originate both as tubal or ovarian pregnancies.[4]

Reported cases

According to one report there are only 300 known cases of stone baby in the world.[5] The chance of abdominal pregnancy is one in 11,000 pregnancies; only between 1.5 and 1.8% of abdominal pregnancies develop into lithopedia.[6]

Patient
(age at time of diagnosis)		 Location Date of pregnancy Date of removal
(case duration)
 Additional information
Colombe Chatri (68)* Sens,  Kingdom of France 1554 1582
(28 years)		 Chatri became pregnant for the first time at 40, but never gave birth after breaking her water and going through labor pains. She was bedridden for the next three years, during which she could notice a hard tumor on her lower abdomen, and complained of tiredness and abdominal pains for the rest of her life. After her death, her widower requested two physicians to examine her body, who discovered a fully formed, petrified baby girl, with remains of hair and a single tooth.[4]
Anna Mullern (94)* Leinzell, Swabia,  Holy Roman Empire 1674 1720
(46 years)		 Aged 48, Mullern became pregnant, broke her water and went through labor pains for seven weeks without giving birth, retaining a swollen belly afterwards. She would suffer pain when exercising for the rest of her life, but she was able to become pregnant again and gave birth to a healthy boy and girl. Convinced that she had been pregnant and carried the previous baby with her still, Mullern made the local physician and surgeon swear that they would open her body after her death. The physician did not survive her, but the elderly surgeon fulfilled his promise with the help of his son, finding "a hard mass of the form and size of a large Ninepin-Bowl" that contained a petrified fetus inside.[7]
Randi Jonsdatter (50) Kvikne, Hedmark, Denmark Denmark-Norway 1803 1813
(10 years)		 Patient "gave birth" to a petrified baby divided in two parts, through a cut performed over Jonsdatter's belly button. She lived for many years after without problem.[8]
Rebecca Eddy (77)* Frankfort, New York,  USA 1802? 1852
(c.50 years)		 Aged 27 and in her first pregnancy, Eddy went through what seemed to be labor pains after an accident with a large kettle over the fire, but the pains disappeared a few days later and she never gave birth. William H. H. Parkhurst examined her in 1842, noting the "largeness, hardness and irregularity" of her abdominal lump; he would perform her autopsy in front of 20 witnesses when she died a decade later. During the process Parkhurst found "a perfect formed child... weighing 6 pounds avoirdupois (2.7 kilograms)" who "had no adhesions or connections with the mother except to the Fallopian tubes, and the blood vessels which nourished it, and which were given off from the mesenteric arteries... the child was almost floating in the abdomen."[9]
Unknown (54) Jamaica 1957 1966
(9 years)		 The patient, who had given birth previously, had a swollen belly and noted movement inside, but did not believe she was pregnant because she continued to menstruate, albeit irregularly. The movements ceased shortly after being admitted to a Kingston hospital but the bleeding and pain continued until she was operated on 8 months later. Although her belly had deflated, the patient still felt a mass inside, but was told by her doctor that it was not important. The pain resumed years later, when the woman had migrated to Toronto, Canada, and she was relieved of an oval-shaped, calcified mass of 8 X 4 X 3 cm.[10]
Unknown (60)  Thailand 1959 1987
(28 years)		 [11]
Unknown (76)  Republic of China 1950 1999
(49 years)		 Patient was originally diagnosed with a benign tumor in 1950, but refused the operation to extract it.[12]
Unknown (67) Washington State,  USA 1962 1999; not extracted
(37 years)		 Admitted with abdominal pain, the patient reported to have "missed the baby" during a pregnancy 37 years prior, but refused intervention. She suffered no consequences and carried a second intrauterine pregnancy to term with no problem. Pain episode resolved and patient released without attempt of extraction.[13]
Unknown (40)  Brazil 1982 2000
(18 years)		 The "patient reported regular abdominal growth and healthy fetal activity from a pregnancy that happened 18 years earlier. She had never done pre-natal follow-up. In the third trimester, she had started to feel strong cramps in the lower abdomen at the same time that fetal activity disappeared. She had not looked for medical assistance and some weeks later she had eliminated a dark red mass through the vagina with a placental appearance. She had experienced the characteristic modifications of breast lactation. The abdomen had started to decrease but retained an infra-umbilical mass of about 20 centimeters in diameter, mobile and painless."[5]
Zahra Aboutalib (75) Grand Casablanca,  Morocco 1955 2001
(46 years)		 Probably the most documented case. Heavily pregnant, Aboutalib went through labor pains for 48 hours at her own home before being taken to a hospital, where she was scheduled for a cesarean section. However, after witnessing another young woman dying during the procedure she feared for her life and fled the hospital. The pain ceased days later and did not return for 46 years, when the still unidentified lithopedion was initially mistaken for an ovarian tumor. Aboutalib never bore children again after her ectopic pregnancy, but adopted three.[14][15][16]
Unknown (80)  South Africa 1960 2001
(c.40 years)		 An 80-year-old 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.[17]
Unknown (63)  South Korea 1961 2001
(40 years)		 Postterm abdominal pregnancy extended beyond nine months, after which fetal movement ceased and the mother suffered from vaginal bleeding, but never gave birth. The patient became pregnant again and gave birth to a healthy baby girl two years later.[18]
Unknown (33)  Ghana 1990 2002
(12 years)		 Third pregnancy after two natural miscarriages. Patient experienced abdominal pain, bilateral tubal blockage and infertility.[19]
Unknown (40)  India 1999 2007
(8 years)		 Only known case of twin lithopedia. One embryo grew in each ovary until both died 5 months into development; the patient assumed she had suffered a normal natural miscarriage. She had pain in both sides of the lower abdomen through the following 8 years, when it was joined by abdominal distention, vomiting and intestinal constipation.[6]
Unknown (31) Curaren, Francisco Morazán,  Honduras 1995 2008
(13 years)		 The ectopic pregnancy happened shortly after the birth of the patient's first child. Afterwards she was pregnant seven times more, giving birth to her last child just two months before the diagnosis.[20]
Unknown (68) Northern Cape,  South Africa 1986 2011; not extracted
(25 years)		 Fourth pregnancy, when the patient was aged 44. Resulted in infertility, which was taken for a case of early menopause, but was otherwise asymptomatic.[21]
Unknown (37) Malongo,  Democratic Republic of the Congo 2009 2011
(3 years)		 Patient went through the same experience as in her previous eight pregnancies, but "the baby never came out". Surgeons retrieved a calcified 32 weeks fetus from the abdominal cavity; the ovaries and uterus were intact and the patient had her period regularly.[22]
Unknown (32) Santa Clara, Waspam,  Nicaragua 2010 2011
(35 weeks)		 Patient in her third pregnancy. Was hospitalized because she did not feel fetal movement anymore.[23]
Antamma (70) Mominpur, West Bengal,  India 1977 2012
(35 years)		 Admitted to hospital after complaining of stomach pain for some time. The patient had delivered three healthy children after this incomplete pregnancy.[24]
Huang Yijun (92)  People's Republic of China 1948 2013
(65 years)		 Longest known case. Patient was informed that the fetus had died inside her in 1948, but did not remove it earlier for lack of money.[25]
Unknown
(82)		 Bogota,  Colombia 1973 2013 (discovered)
(40 years)		 Patient originally thought to be suffering from gastroenteritis but an abdominal radiography discovered a calcified fetus in her abdomen.[26]
Unknown
(70)		 Tamil Nadu,  India 1962 2014 (discovered)
(52 years)		 Patient presented with history of purulent discharge per vagina. Treated as purulent inflammation of cervix after biopsy report. Subsequently, condition resolved followed by history of pain and breathlessness. On radiography, it was found that the patient had a lithopedion fetus in her abdomen. She was asymptomatic through her reproductive life.
Unknown
(84)		 Tocantins State, Brazil 1970 2014, not extracted (44 years) Patient was having abdominal pain, when doctors discovered the fetus. She claimed to have been pregnant more than 40 years prior. After extreme pain back then, she saw a local traditional healer who gave her medication that ended the pain, and —she had assumed— miscarried the baby.[27]
Estela Meléndez
(90)		 San Antonio, Chile, Chile 1965 2015 (not extracted) (50 years) A 2 kg (4.4 lb) calcified foetus was discovered in the abdomen of a 90-year-old Chilean woman. The discovery was made during an X-ray examination after the lady was brought to the hospital following a fall. The lithopedion, which is believed to have been there for 50 years, was so large and developed, it occupied the whole abdominal cavity. The foetus was not removed on the grounds of the patient's age.[28]
* After natural death of the patient.

Notes

  1. ↑ Perper, J.A. (2006): Chapter III: Time of Death and Changes after Death. Part 1: Anatomical Considerations. In: Spitz, W.U. & Spitz, D.J. (eds): Spitz and Fisher’s Medicolegal Investigation of Death. Guideline for the Application of Pathology to Crime Investigations (Fourth edition), Charles C. Thomas, pp.: 87-127; Springfield, Illinois.
  2. ↑ Rothschild BM, Rothschild C, Bement LC; Rothschild; Bement (July 1993). "Three-millennium antiquity of the lithokelyphos variety of lithopedion". American Journal of Obstetrics and Gynecology. 169 (1): 140–1. doi:10.1016/0002-9378(93)90148-c. PMID 8333440.
  3. ↑ Wednesday Wonders #3: The Lithopedion
  4. 1 2 Bondenson, Jan (2000) The Two-headed Boy, and Other Medical Marvels. Cornell University, pgs. 39-41
  5. 1 2 Passini, Renato; Knobel, Roxana; Parpinelli, Mary Ângela; Pereira, Belmiro Gonçalves; Amaral, Eliana; de Castro Surita, Fernanda Garanhani; de Araújo Lett, Caio Rogério (November 2000). "Calcified abdominal pregnancy with eighteen years of evolution: case report". São Paulo Medical Journal. 118 (6): 192–4. doi:10.1590/S1516-31802000000600008. PMID 11120551.
  6. 1 2 Mishra JM, Behera TK, Panda BK, Sarangi K; Behera; Panda; Sarangi (September 2007). "Twin lithopaedions: a rare entity" (PDF). Singapore Medical Journal. 48 (9): 866–8. PMID 17728971.
  7. ↑ Bondenson, Jan (2000) The Two-headed Boy, and Other Medical Marvels. Cornell University, pgs. 46-47
  8. ↑ Stengel C., Udfaldet af et tiaarigt Svangerskab, Eyr, Vol. 2, 1827, Pags. 134–7.
  9. ↑ Bernard, Grace Parkhurst (1947). "Lithopedion from the Case of Dr. William H. H. Parkhurst, 1853". Bulletin of the History of Medicine. 21 (3): 377–8. PMID 20257377.
  10. ↑ Chase, A. L. (1968). "Lithopedion". Canadian Medical Association Journal. 99 (5): 226–30. PMC 1924357Freely accessible. PMID 5671128.
  11. ↑ Srisomboon, Jatupol; Maneewattana, Trong; Simarak, Suri; Koonlertkij, Sompong; Sirivatanapa, Pannee (March 1988). "Chronic abdominal pregnancy (Lithopedion): A case report". Chiang Mai Medical Journal. 27 (1): 45–52.
  12. ↑ http://homepage.vghtpe.gov.tw/~jcma/6406/640608.pdf[]
  13. ↑ Frayer CA, Hibbert ML; Hibbert (July 1999). "Abdominal pregnancy in a 67-year-old woman undetected for 37 years. A case report". The Journal of Reproductive Medicine. 44 (7): 633–5. PMID 10442329.
  14. ↑ "Zahra Aboutalib – The 46 Year Pregnancy". RareHumans.com. Retrieved 21 August 2013.
  15. ↑ Rosenhek, Jackie (September 2008). "Fetal rock". Doctor's Review. Montreal: Parkhurst. Retrieved 21 August 2013.
  16. ↑ "The 46-Year Pregnancy". Extraordinary People. Season 3. Episode 1. 23 March 2005. 60 minutes in. Channel 5 (UK).
  17. ↑ Lachman N, Satyapal KS, Kalideen JM, Moodley TR; Satyapal; Kalideen; Moodley (2001). "Lithopedion: a case report". Clinical Anatomy. 14 (1): 52–4. doi:10.1002/1098-2353(200101)14:1<52::AID-CA1009>3.0.CO;2-H. PMID 11135399.
  18. ↑ Kim, Mi Suk; Park, Soyoon; Lee, Tae Sung (April 2002). "Old abdominal pregnancy presenting as an ovarian neoplasm". Journal of Korean Medical Science. 17 (2): 274–5. doi:10.3346/jkms.2002.17.2.274. PMC 3054860Freely accessible. PMID 11961318.
  19. ↑ http://www.txfertility.com/forms/38%20Lithopedion%20laproscopic%20diagnosis%20and%20removal.pdf[]
  20. ↑ http://www.bvs.hn/RMH/pdf/2006/pdf/Vol74-3-2006-6.pdf[]
  21. ↑ Ede J, Sobnach S, Castillo F, Bhyat A, Corbett JH; Sobnach; Castillo; Bhyat; Corbett (August 2011). "The lithopedion - an unusual cause of an abdominal mass". South African Journal of Surgery. 49 (3): 140–1. PMID 21933501.
  22. ↑ http://hcp.obgyn.net/pregnancy-and-birth/content/article/1760982/1979439[]
  23. ↑ http://www.redalyc.org/pdf/1800/180023391011.pdf[]
  24. ↑ "35 year old 'stone baby' removed from 70 year old woman's womb". Siasat.com. Retrieved 2012-02-05.
  25. ↑ Osayimwen, Etinosa (2 April 2013). "92-yr-old woman Miraculously delivers 'stone baby' after 60 yrs pregnancy". The Herald. Retrieved 21 August 2013.
  26. ↑ Nelson, Sara (12 December 2013). "Stone Baby: Doctors Find 40-Year-Old Lithopaedion Foetus In Body Of Woman, 82". Huffington Post UK. Retrieved 12 December 2013.
  27. ↑ Smith, Lydia (12 February 2014). "Four Decades Old 'Stone Baby' Inside Brazilian Pensioner". International Business Times. Retrieved 13 February 2014.
  28. ↑ "Chilean woman 'carried calcified foetus for 50 years'". BBC News. 20 June 2015.

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