INTRODUCTION:

A stone baby, or lithopedion, is a rare medical phenomenon where a deceased fetus remains within the mother’s abdomen and undergoes calcification. The calcification protects the mother from infection by encasing the fetus in calcium, essentially turning it to stone. This typically arises from an abdominal pregnancy that has not been diagnosed or treated. If the fetus cannot survive and is unable to be reabsorbed by the body, the immune system might initiate calcification as a protective measure against possible infections^.1

The term "Lithopedion" is derived from the Greek words "Lithos," which translates to stone, and "paidion," meaning child. This condition is becoming rarer as a result of improved access to prenatal care.

Definition:

Lithopedion, commonly referred to as a "stone baby," is an uncommon outcome of an ectopic pregnancy where the fetus dies and subsequently undergoes calcification.

A lithopedion or stone baby, is a rare phenomenon which occurs most commonly when a fetus dies during an abdominal pregnancy, 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.²

Incidence:

Lithopedion is quite uncommon, occurring in only about 1.5% to 2% of ectopic pregnancies and representing a mere 0.0054% of all pregnancies. Patients who experience this condition typically range in age from 30 to 100 years, and the length of time lithopedion is retained can vary significantly, spanning anywhere from 4 to 60 years.

Lithopedions cannot develop unless the fetus survives for more than 3 months because, before this time, the bones are still cartilaginous, and the absorption will be fast and complete.⁴

History:

The Arabic surgeon Albucasis first described lithopedion in the 10th century.¹⁰Küchenmeister's 1881 article is the basis of the current classification of lithopedion.

The first documented case of a stone baby dates back to 1582 when an autopsy revealed one in a woman from Sens, France, who had carried it for 28 years.

Recently, there have been notable cases of lithopedion involving two women from different backgrounds.

Firstly, a 35-year-old woman, who had been suffering from chronic abdominal pain and expressed a strong desire to become pregnant, was found to have a lithopedion located in her left fallopian tube. This was confirmed through both an ultrasound and a CT scan, with a laparotomy further verifying the presence and location of the calcified embryo.³

In another case, a 50-year-old Congolese refugee, with a history of carrying a retained fetus for nine years following fetal demise, was diagnosed with lithopedion. She presented with abdominal pain, dyspepsia, and gurgling sensations after meals. Although she chose to avoid surgery in favor of monitoring her symptoms, unfortunately, she later succumbed to malnutrition and bowel obstruction.⁵

Other lithopedion cases:

A 74-year-old woman welcomed a healthy baby boy after an abdominopelvic CT scan indicated a calcified mass.

A case of lithopedion in a postmenopausal woman

Additionally, there was a case of lithopedion that led to intestinal obstruction in a 71-year-old woman.

Huang Yijun, 92, of southern China, delivered a child which she had been carrying for well over half a century. The baby was not alive, however.

Several factors may lead to the development of a lithopedion:

· Delayed Diagnosis: Sometimes, an ectopic pregnancy goes unnoticed for a long time, which allows the calcification process to start.

· Location of Implantation: Where the ectopic pregnancy implants is crucial. Pregnancies that occur in the abdomen are more prone to calcification.

· Maternal Age: Women of older maternal age are more likely to experience lithopedion formation, likely due to changes in reproductive anatomy and function.

· The fetus surviving beyond three months

· Sterility of the fetus

· The mother's immune system recognizing the fetus as a foreign body

· Conditions that are conducive to the deposition of calcium.

Classification:

· Lithokelyphos (egg shell): The membranes alone are calcified

· Lithokelyphopedion (stone sheath child): Both the membranes and the fetus are calcified

· True lithopedion (stone child): The fetus is infiltrated with calcium salts⁶

Symptoms:

Lithopedion, also known as a stone baby, is a rare condition that can have no symptoms or vague symptoms. Occasionally, they may produce acute symptoms that necessitate medical attention.

When symptoms do occur, they can include:

· Abdominal pain,

· Pelvic pain or mass

· Abdominal heaviness

· Chronic constipation

· Digestive disturbances.

Lithopedion can remain asymptomatic for years or decades. It is frequently found incidentally when imaging the abdomen for unrelated medical concerns, during surgical procedures, or at autopsies.⁹

Investigations:

Investigations for a stone baby, also known as a lithopedion, typically involve imaging studies and laboratory tests.

Imaging Studies:

· A calcified fetus and investing membranes on a plain film of the abdomen

· Computerized tomographic (CT) findings

· Magnetic resonance imaging (MRI) scans

· Excretory urography

· Barium enema examination

· Ultrasound

Laboratory Tests:

Urine Tests: Can reveal elevated mineral levels associated with the formation of stones.

Blood Tests:

Measures certain minerals in the bloodstream that may contribute to stone formation.

Complete Blood Cell (CBC) Count:

Helpful for known or suspected stone disease.

Electrolyte Levels⁷

Treatment:

Treatment options for lithopedion vary based on the size and position of the calcified mass, the patient's overall health, and the presence of any symptoms.

· Observation:

For cases where symptoms are absent, the condition can simply be monitored through regular imaging.

· Surgery:

If the patient experiences pain, discomfort, or complications such as infection or obstruction, surgical intervention may be required. The specific surgical procedure will depend on both the size and location of the mass, alongside the patient’s general health.

Laparotomy, a traditional open surgery, might be necessary for larger or more complex masses. In contrast, laparoscopy offers a less invasive alternative for smaller masses.⁸

Complications:

Reported complications from lithopedion formation include:

· Intestinal obstruction

· Pelvic abscess

· Cephalopelvic disproportion with future pregnancy

· Tubal infertility

· Fertility issues

· Post-traumatic intestinal perforation

· Fistulisation of fetal parts in abdominal wall, rectum or vagina

· Pelvic abscess

CONCLUSION:

The case of lithopedion underscores persistent challenges related to prenatal care in various regions of developing countries. Advanced imaging methods like computed tomography are essential for diagnosing this condition, providing a clear view of the related anatomy.⁹

Fortunately, lithopedion has become relatively uncommon due to improved access to prenatal care, which facilitates early detection and timely medical intervention.⁷

Treatment options may vary, leaning towards either conservative or surgical methods, based on a careful consideration of the specific risks and benefits involved. In instances where surgery is safe, it is typically regarded as the preferred course of action.

REFERENCES:

1. https://www.medicoverhospitals.in/diseases/lithopedion/

2. https://www.instagram.com/doctor.justin/reel/C66kxR0RaKk/

3. https://www.annsaudimed.net/doi/10.5144/0256-4947.1996.69

4. Anand S. Huchappa, Karthik Raghuveer, Anugrah Suresh,” Lithopedion: the calcified marvel”,International Journal of Reproduction, Contraception, Obstetrics and Gynecology Huchappa AS et al. Int J Reprod Contracept Obstet Gynecol. 2024 Jun; 13(6):1603-1605

5. Sous, W., Sous, M., Soipe, A. et al. A 50-year-old refugee woman with a lithopedion and a lifetime of trauma: a case report. BMC Women's Health. 2023; 23: 89. https://doi.org/10.1186/s12905-023-02244-z

6. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1711474.pdf

7. Morales, A., Aguilera, G., and Krause, D. Lithopedion: An unusual cause of an abdominal calcified mass. The Indian journal of Radiology and Imaging. 2020; 30(2): 244–245. https://doi.org/10.4103/ijri.IJRI_452_19

8. Gebresenbet, F., Mulat, A., Nur, N. et al. Neglected intrauterine fetal demise for more than two decades leading to the development of a lithopedion: a case report. J Med Case Reports. 2019; 13: 330 . https://doi.org/10.1186/s13256-019-2264-8

9. Coumba Gueye, Ibrahima Niang, Ousmane Sano, Moustapha Toure, Serigne Talla Faye, Khaoulah Talhaoui, Hamidou Deme,Case report of a lithopedion of tubal location, in a young woman,Radiology Case Reports. 2023; 18(4): 1552-1555

10. https://www.google.com/search?q=lithopedion+notes

Received on 13.03.2025 Revised on 12.04.2025

Accepted on 08.05.2025 Published on 21.05.2025

Available online from May 22, 2025

Asian J. Nursing Education and Research. 2025;15(2):106-108.

DOI: 10.52711/2349-2996.2025.00023

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