Lithopedion Following Presumed Primary Abdominal Pregnancy in a 42-Year-Old Woman from Somaliland: A Case Report and Literature Review.

BACKGROUND

Lithopedion is an exceptionally rare complication of abdominal pregnancy in which a deceased fetus becomes calcified following prolonged retention in the maternal abdomen. Because of its indolent course and nonspecific symptoms, it is frequently diagnosed late, particularly in resource-limited settings.

CASE PRESENTATION: We report a 42-year-old multiparous woman (gravida 4, para 3) who presented with a three-year history of chronic lower abdominal pain and progressive abdominal heaviness. She had a remote history suggestive of an untreated pregnancy that spontaneously ceased without medical evaluation. Clinical examination revealed a firm, irregular, non-mobile abdominopelvic mass extending to the umbilical level. Laboratory investigations revealed mild anemia (hemoglobin 9.0 g/dL), while serum β-hCG was <5 mIU/mL (negative). Ultrasonography demonstrated a calcified abdominopelvic mass with an empty uterine cavity. Contrast-enhanced computed tomography with three-dimensional reconstruction demonstrated a well-defined calcified extrauterine fetal skeleton consistent with lithopedion. Intraoperative findings met Studdiford's criteria; however, because these criteria were applied retrospectively several years after the index pregnancy, the underlying gestation is described as a presumed primary abdominal pregnancy.

MANAGEMENT AND OUTCOME: The patient underwent exploratory laparotomy with complete surgical excision of the calcified fetus without intraoperative complications. Postoperative recovery was uneventful, and the patient demonstrated complete resolution of symptoms at follow-up.

CONCLUSION

Lithopedion should be considered in women presenting with chronic abdominal or pelvic symptoms and a history suggestive of prior untreated pregnancy. In this patient, cross-sectional imaging, and particularly CT with three-dimensional reconstruction, was valuable for characterizing the lesion and planning surgery, although ultrasonography and magnetic resonance imaging may be sufficient in other circumstances. Surgical management in symptomatic cases can result in excellent outcomes even in resource-limited settings.