Lithopaedion

 

Vigy Elizebth Cherian

Assistant Professor, Sharda University, Greater Noida, NCR, Delhi

 

ABSTRACT:

Lithopedion (litho = stone; pedion = child) that evolves to fetal death and calcification. It is the other name given to an extra-uterine pregnancy. It is a rare phenomenon that mostly comes under an abdominal pregnancy. Lithopedion were first discovered in 1557. The incidence of abdominal pregnancy is 1:11,000 pregnancies and lithopedion seen in 1.5 to 1.8% of these cases. In world medical literature there have been less than 300 cases in 400 years due to the increase in inflammatory pelvic disease and uterine tubes surgery and also there has been an increase in ectopic pregnancy. It is encountered condition; an undiagnosed and untreated advanced abdominal pregnancy is present. The dead fetus is retained in the maternal abdominal body and later followed by calcification of the foetus¹. Due to medical and pre-natal care becoming more accessible to the population the occurrence of abdominal pregnancy and lithopedion has tended to become even rarer with the possibility of early diagnosis and treatment of the pathology.

 

 

INTRODUCTION:

A lithopedion – also spelled lithopaedion or stone baby, is a rare condition which occurs most commonly when a fetus dies during an abdominal pregnancy. It is too large to be reabsorbed by the body, and calcifies on the outside as part of a foreign body reaction, shielding the mother's body from the dead tissue of the fetus and preventing infection¹. A lithopedion babies or stone baby is formed when a fetus growing outside of the uterus dies. It is too large to be reabsorbed back into its mother and the child calcifies to keep the mother safe from infection. Lithopedion babies are mostly occurring in ectopic pregnancies. It is only 13 of the reported cases of lithopedions were uterine, and the resulting stone children were found in the abdomen after the uterus ruptured during birth.

 

 

Many women who have lithopedions go on to have other children, carrying their flesh-and-blood children in the same body that's housing their child of stone².

 

DIFFERENTIAL DIAGNOSIS:

Diagnosis is usually straightforward, but differential hypotheses might include:

·       Fetus in Fetu

·       Mature Ovarian Teratoma¹

 

DEFINITION:

Lithopaedions, also referred as stone babies, are a rare phenomenon which occurs most commonly when a fetus dies during an ectopic pregnancy².

 

HISTORY AND ETYMOLOGY:

It derives from the Ancient Greek roots, litho = stone and paedion = child. The earliest known lithopedion was found in an archaeological excavation at Bering Sinkhole, on the Edwards Plateau in Kerr County, Texas, and dated to 1100 BC. Another early example was found in a Gallo-Roman archaeological site in Costebelle, southern France, dating to the 4th century¹.

 

The condition was first described in a treatise by the Spanish Muslim physician Abū al-Qāsim (Abulcasis) in the 10th century. By the mid-18th century, a number of cases had been documented in humans, sheep and hares in France and Germany. In a speech before the French Académie Royale des Sciences in 1748, surgeon Sauveur François Morand used lithopedia both as evidence of the common nature of fetal development in viviparous and oviparous animals, and as an argument in favor of cesarean section².

 

In 1880, German physician Friedrich Küchenmeister reviewed 47 cases of lithopedia from the medical literature and distinguished 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 and ovarian pregnancies, although tubal pregnancy cases are more common².

 

EPIDEMIOLOGY:

The estimated incidence is at ~ 1.5 to 1.8% of abdominal ectopic pregnancies. According to one report there are only 300 known cases of lithopedia in the world, recorded in over 400 years of medical literature. While the chance of abdominal pregnancy is one in 11,000 pregnancies, only between 1.5 and 1.8% of these abdominal pregnancies may develop into lithopedia³.

 

CLASSIFICATION

(I) In 1880, German physician Friedrich Kuchenmeister identified three subgroups

1)   Lithokelyphos (“Stone Sheath”), where calcification occurs on the fetal membranes and not the fetus and the fetus degenerates within them.

2) Lithotecnon (“Stone Son”) or “true” lithopedion, where the fetus itself is calcified after entering the abdominal cavity, following the rupture of the placental. (No calcification of the membranes).

3) Lithokelyphopedion (“Stone Sheath and Child”), when both fetus and membranes are calcified³.

(II) D’Aunoy and King (1922) listed four changes which an abdominal fetus may undergo if it is not removed.

1.     Skeletonization- where only the bones of the foetus remain following the disintegration and absorption of the soft parts.

2.     Adipocere- where the soft parts are replaced by fatty acids, soaps and salts of palmitic and stearic acids.

3.     Suppuration- where the foetus is destroyed after an abscess has formed, usually due to E. coli infection.

4.     True lithopaedion- formation occurs if the foetus remains sterile and to varying degrees becomes infiltrated with calcium salts. Suppuration³

 

PATHOLOGY:

If the deceased fetus is too large to be re-absorbed by the mother’s body it becomes a foreign body to the mother’s immune system. To protect itself from possible infection, the mother’s body will encase the fetus in a calciferous substance. The fetus is gradually mummified becoming a stone baby. Lithopedions may occur from 14 weeks’ gestation to full term. It is not unusual for a stone baby to remain undiagnosed for decades and found incidentally when taking plain films for various reasons³.

 

SYMPTOMS:

Although symptoms such as pelvic pain, abdominal tenderness and compressive symptoms to the urinary bladder and rectum may occur, most cases remain asymptomatic during large periods of time and represent incidental findings on imaging studies, surgery or necropsy⁴

 

DIAGNOSISTIC EVALUATION:

·       History collection (regular menstrual bleeding starting at the menarche and again after pregnancy)

·       Physical examination (revealed an infra-umbilical mass)

·       Abdominal X-ray

·       Computerized tomography (showed the presence of an ectopic fetus in a mesentery blood vessel branch, with peripheral calcifications)

·       Ultrasound examinations (showed an empty uterus, regular ovaries and the presence of a 31-week fetus -determined from femur length)³.

 

COMPLICATIONS:

·       Intestinal obstruction

·       Pelvic abscess

·       Cephalopelvic disproportion with future pregnancy

·       Tubal infertility⁴

 

REFERENCES:

1.        Costa SD, Presley J, Bastert G. Advanced abdominal pregnancy. Obstet Gynecol Surv 1991; 46:515-25.

2.        Frayer CA, Hibbert ML. Abdominal pregnancy in a 67-year-old woman undetected for 37 years: a case report. J Reprod Med 1999; 44:633-5.

3.        Irick MB, Kitsos CN, O'Leary JA. Therapeutic aspects in the management of a lithopedion. Am Surg 1970; 36:232-4.

4.        Spiritos NM, Eisenkop SM, Mishell DR. Lithokelyphos: a case report and literature review. J Reprod Med 1987; 32: 43-6.

 

 

 

 

Received on 06.02.2019          Modified on 28.02.2019

Accepted on 21.03.2019     © A&V Publications all right reserved