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A lithopedion (also spelled lithopaedion or lithopædion; from Ancient Greek: λίθος "stone" and 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 foreign body reaction, shielding the mother's body from the dead tissue of the fetus and preventing infection.

A 77-year-old female patient from Tumaco, in the Pacific coast of Colombia, presented with 8 days of generalized abdominal pain associated with symptoms of absent peristalsis. She referred 4 pregnancies, of which she had had 3 normal vaginal deliveries and 1 miscarriage (40 years prior), which was recognized by the patient as her last pregnancy. Additionally, she mentioned a family history of colon cancer. Upon admission to the emergency department, she was hemodynamically stable, with no signs of peritoneal irritation but a positive ascitic wave. There were no palpable masses, and symptomatic treatment was initiated. Blood tests were requested, which were not suggestive of intrabdominal infection. Plain abdominal X-rays did not show any significant finding; abdominal ultrasound documented a narrow hepatic angle and thickness in the right colon mucosa. Given that imaging findings were not conclusive, a contrasted abdominal CT was performed, revealing thickening of the ascending colon walls, signs of ileocolic intussusception and heterogeneous calcifications in the lower left pelvis compatible with a mummified fetus (Fig. 1). After these findings, a diagnostic laparoscopy was performed with no relevant findings. Therefore, laparotomy was performed finding a mummified fetus with 41 mm biparietal diameter (BPD), adhered to the greater omentum, which was dissected and extracted in block (Fig. 2). Subsequently, a right hemicolectomy was performed. She was then transferred to the intensive care unit (ICU), where she required ventilatory and vasopressor support. After two days in the ICU and a favorable evolution, she was transferred to the general ward and after resolution of the symptoms, she was discharged with no further complication.

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Imaging and operative findings of lithopedion (lithokelyphos) in a 36-year-old African woman complaining of chronic pelvic pain and infertility. A. Computed tomography (CT) image in the transverse plane shows a large pelvic mass with an incomplete rim of calcification (arrow) containing several disorganized fetal bones (extremity long bones, scapula, ribs). B. CT image in the sagittal plane shows skeletal c calc r range

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A 20 years old lady married for 2 years came with complaints of inability to conceive. Her menstrual cycles were regular except for a single missed cycle which occurred about 18 months back. She did not visit any doctor for confirmation of pregnancy. She resumed her menstruation thereafter and continued to have it till date. She however had occasional pain abdomen which was relieved by analgesics she purchased over the counter. Physical examination revealed a lump in the right lumber region hard in consistency with restricted mobility and tender on movement. Laboratory workup revealed no abnormal values. X-ray of abdomen and pelvis in erect posture revealed radio-opaque shadow resembling foetal skeleton in right lumber region (Figure 1). Ultrasound examination confirmed intraperitoneal dead, calcified foetus of approximately 17 weeks gestational age along with an echogenic mass in left adnexa.

With these findings, a provisional diagnosis of lithopedion was made and laparotomy was planned. A hard globular mass adherent to the omentum was found in the right flank. The mass was dissected off the omental tissue and a calcified foetal skeleton was recovered (Figure 2). Fallopian tube on the left side in the isthmic region contained a rent with a calcified growth that filled the tube causing a localized distension (Figure 3). This was confirmed to be calcification of degenerated chorionic tissue by histopathology with no evidence of inflammation. Left sided salphingectomy was done. Contralateral tube and bilateral ovaries were normal. Pouch of douglas was free of adhesion. Postoperative recovery was uneventful and patient was discharged on 7th postoperative day. Only 4 months after the surgical procedure, the patient again visited our OPD with complaints of cessation of menstruation for 2 months. Intrauterine gestation was confirmed. Patient attended antenatal clinic regularly. She subsequently delivered at 38 weeks a healthy female baby weighing 2.8 kg spontaneously.

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More examples.

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A 47-year-old woman came to a surgical mission in Haiti in 2016 desiring surgical management of heavy menstrual periods. She reported having had 5 pregnancies and deliveries. She denied any history of other medical problems or surgeries but had received little medical care in her life because of poor access to health care. An examination revealed a 16-week uterus consistent with fibroid tumors. Total abdominal hysterectomy, left salpingo-oophorectomy, and right salpingectomy were performed. On initial intraoperative examination of the pelvic cavity, significant adhesions were present that involved the uterus and bilateral adnexa; adhesions were filmy in nature but extensive. The right ovary was obscured by adhesions that encased it against the right pelvic sidewall, so it was left in situ. Although these findings suggested a history of pelvic inflammatory disease, shortly after, an alternative explanation presented itself when a lithopedion was discovered in the posterior cul-de-sac ( Figure 1 ). The lithopedion was free-floating and was removed without requiring disruption of adhesions or anatomy. The fetal skeleton was well-preserved with many identifiable structures that included humeri, radii, ulnas, metacarpals and phalanges, ribs, a scapula, and an eyeball. The gestational age was estimated at 13 weeks by a humerus length of 12 mm ( Figure 2 ).

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Lithopedion is a rare phenomenon resulting from an extra-uterine pregnancy that advances to fetal demise and calcification and there are less than 300 cases reported in 400 years of medical literature. This rare condition was first described by a surgeon of the Arabic era of medicine in the 10th century. This case report is a 26-year-old, multiparous woman who had presented a lower abdominal pain for long time and she had never attended in pre-natal clinic. She came to our hos- pital with pain and tumoral mass in infra-umbilical area and then we referred to radiology center, after that ultrasound examination of radiology center demonstrated an extra-uterine abdominal 30-week pregnancy measuring the femoral length, this for first diagnosis of radiology center. After laparotomy was performed we met an oval shaped mass that attached the omentum in peritoneal cavity and this mass was a fetus retention of 5 years without calcified ovular membranes but the fetus was calcified so this type is called lithopedion that describes according to the Kuechen- meister classification in 1881. She made good post-operative recovery after extraction the stone baby.

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The case was an 87-year-old woman, and she was transferred to the morgue department in April 2014 to determine the cause of death. During autopsy, an intraabdominally located calcified dead fetus and a 12-cm diameter calcified cyst in the right ovary were inciden- tally detected. It was aged 25 to 29 weeks (according to femur and humerus measurements) with a size of 12.5
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5 cm and a weight of 227 g. Ac- cording to investigation reports, her husband died in 1990, and she had 3 deliveries, the most recent of which was in 1946. Because the menopause age of the case was not exactly known, the retention time of the lithopedion was supposed to be 24 to 68 years according to the date of the most recent pregnancy and the date of her spouse's death. It is the first case that has been incidentally detected and identified during an autopsy in Turkey and also one of the oldest cases in the literature.

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The oldest known example of a Lithopedion was found during an archaeological excavation in the Bering Sinkhole, 41KR241, on the Edwards Plateau in Kerr County, Texas.[i] It was deemed to be a Lithokelyphos variety of Lithopedion. The site was used as a burial ground between 2000 and 7000 years ago, with the Lithopedion found in the uppers layers, suggesting a date of 3100 tears ago.[ii] The Lithopedian was described in the following way: “On the basis of the size of the posterior spinal elements, the fetus was estimated to have died at 7 to 9 months of gestation. The elements were totally skeletonised and bound by a thickened, calcified membrane.” The calcification was “amorphous” and lacking in bone tissue or structure[iii], suggesting that the stony structure had not been formed from bone tissue.

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Doctors in the small Chilean town of La Boca have found a calcified fetus in the uterus of an elderly woman who says she never realized she got pregnant.

Estela Meléndez, 91, says she has had a lump on her belly for many years, but had no idea that she was carrying a fetus. Doctors say it has been in her uterus for over six decades. The fetus is calcified and poses no health risk to the woman.

Meléndez has difficulty hearing and in recent years her gait has been slowed by arthritis. But otherwise she’s doing fine. She’s a resident of La Boca, a town located where the Rapel River meets the Pacific Ocean in the municipality of Navidad.

It was not until she recently suffered a fall that doctors spotted something on her X-ray that caused concern.

“The doctor said I had a tumor and that they needed to operate on me,” Meléndez told CNN. But when a second X-ray was ordered to confirm, doctors couldn’t believe their eyes. The mass they were looking at turned out not to be a tumor, but a fetus.

“I have the lump here,” Meléndez says, touching her belly.

For the elderly woman and her family, the finding has been quite a shock. Meléndez’s husband of 74 years, Manuel González, died in January at age 91. González made a living as a fisherman and a boater in the coastal town. One of her few regrets, Meléndez says, is that she and her husband were unable to have children.

“We suffered tremendously because of this reason,” Meléndez said.

“Can you imagine? More than 60 years!” said Luis Meléndez, the woman’s nephew. “I wonder how she never felt bad once the fetus died inside of her.”

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A 36 year old para 1+0 woman presented with a seven year history of lower abdominal swelling following a natural conception. She had noticed quickening at around the fifth month and started appreciating fetal movements had booked for routine antenatal care. Un- fortunately, she did not have a booking or any subse- quent ultrasounds done due to financial constraints. Her subsequent antenatal care was inconsistent. She howev- er experienced loss of fetal movements but did not seek any professional advice. She was however conscious of her increasing abdominal girth and this raised curiosity among her peers and relatives.
Her past obstetric and gynecological history was not sig- nificant. She was however on follow-up for a psychiatric disorder at a local institution. She was single and still dependant on her mother. When she presented to us she was in good general condition. The abdominal exami- nation revealed a firm mass of approximately 22 weeks gestation, associated with mild abdominal tenderness. The rest of the systemic exam was unremarkable. An ab- dominal Ultra sound showed an abdominal pregnancy of approximately 28 weeks gestation, with an empty uterus.
Upon obtaining an informed consent, we performed an explorative laparatomy. An extended midline incision was used; omental adhesions onto the anterior abdomi- nal wall were encountered during abdominal entry. Following dissection, a lithopedion adherent onto the omentum, and firmly adherent to the right ovary was identified (Fig. 1). No separate placental tissue was iden- tified. The uterus, the left ovary and fallopian tubes were normal (Fig. 2). The lithopedion was separated from the omentum, and removed with the adherent ovary (Fig. 3). Further exploration revealed normal abdominal vis- cera and the abdomen was closed. Postoperative follow up was uneventful. Histopathology of the lithopedion revealed a calcified fetus that weighed 1400 g, at approx- imately 28 weeks gestation with external features that appeared normal.