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GYNAECOLOGY AND OBSTETRICS IMAGING Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 813-814
Lithopaedion evolution of an abdominal siamese twin pregnancy-a rare case report


Department of Radiodiagnosis, M.K.C.G. Medical College & Hospital, Berhampur, Dist. Ganjam, Orissa-760 004, India

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Date of Submission20-Sep-2006
Date of Acceptance10-Nov-2006
 

Keywords: Lithopaedion, Abdominal Pregnancy, Siamese Twin

How to cite this article:
Misra P, Bastia B K, Deep N, Rao M, Jena S K. Lithopaedion evolution of an abdominal siamese twin pregnancy-a rare case report. Indian J Radiol Imaging 2006;16:813-4

How to cite this URL:
Misra P, Bastia B K, Deep N, Rao M, Jena S K. Lithopaedion evolution of an abdominal siamese twin pregnancy-a rare case report. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Jul 22];16:813-4. Available from: http://www.ijri.org/text.asp?2006/16/4/813/32355

   Introduction Top


Lithopaedion (litho=stone; paedion=child) is the name given to an extra-uterine pregnancy that evolves to fetal death and calcification. It is usually the result of a primary or secondary abdominal pregnancy. The incidence of abdominal pregnancy is 1:11,000 pregnancies and lithopaedion occurs in 1.5 to 1.8% of these cases [1],[3]. There have been less than 300 cases reported in the medical literature [2],[3],[4]. Because of the increase in inflammatory pelvic disease and uterine tubes surgery, there has been an increase in ectopic pregnancy [1]. On the other hand, the occurrence of abdominal pregnancy and lithopaedion has tended to become even rarer due to medical and pre-natal care becoming more accessible to the population, with the possibility of early diagnosis and treatment of the pathology [1],[4]. We report a rare case of calcified abdominal siamese twin pregnancy with eighteen years of evolution.


   Case report Top


A 45 year old woman came with complaint of lower abdominal pain. The patient reported regular abdominal growth and fetal activity from 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. Thereafter the abdomen had started to decrease and she forgot about it. About one year back she again seeked medical assistance for pain in lower abdomen. Her gynaecologic history was of regular menstrual bleeding starting at the menarche and again after pregnancy. The physical examination revealed an infra-umbilical mass of 26 to 28 week size. The uterus was normal on per vaginal examination. A hard mobile mass was palpable through posterior vaginal fornix. The abdominal radiograph AP view showed a calcified abdominal fetus with two heads (Fig.1). The abdominal radiograph lateral view showed the fetal skeleton overlaying the maternal skeleton confirming the abdominal pregnancy (Fig.2). The US showed an empty uterus, regular ovaries and the presence of an abdominal 28 week fetus (determined from femur length) and another solid calcified mass in the pelvis (consistent with second fetal head as seen in the abdominal radiograph). A hypothesis of lithopedion abdominal siamese twin pregnancy was made. Exploratory laparatomy revealed a partially mummified 28 week siamese twin with two fetal heads in the abdominal cavity (Fig.3).


   Discussion Top


Earliest case of lithopaedion dates back to 1582 A.D., when a 28 year old fetus was found in French woman [5]. In the cases related in the literature the age of the patients on the date of diagnosis varied from 23 to 100 years, two third of them being over 40 years old. The period of fetus retention was from four to sixty years. Fetal death occurred between three and six months of pregnancy in 20% of the cases, between seven and eight months in 27% and at full term in 43% of the cases [2],[4].

Abdominal pregnancy results from the rupture of tubal or ovarian pregnancy with abdominal cavity implantation [1],[3]. The development of this pregnancy is the same as for abdominal intra-uterine pregnancy until fetal death. After this time, dehydration of tissues and calcium infiltration occur [1],[3],[4].

Although most cases remain asymptomatic for years, pelvic pain, weight sensation in the abdomen and compressive symptoms can occur, affecting especially the urinary bladder and rectum [2],[3]. Some associated complications have been reported after a long asymptomatic evolution: urinary bladder and rectum and vagina; intestinal obstruction and volvulus [3],[4].

The diagnosis is revealed by a suggestive clinical history, a pelvic mass found during the physical examination and frequently a radiograph of the abdomen is enough to confirm it [3],[4]. The US shows an empty uterine cavity and a non-specific appearance of the abdominal mass, confusing the diagnosis [2]. CT and MR clearly define the pathology and help the diagnosis of adherence and other organs affected, although these are not absolutely necessary [2],[3],[4]. Some authors suggest excretory urography and barium enema radiograph to evaluate compression or alterations in organs or systems close to it.

The diagnosis differentiates it from other calcified masses like ovarian tumors, myomas, inflammatory masses, teratoma or vascular calcification [4]. Due to the possibility of complications even after years of evolution, the proper procedure is surgical removal.

A case similar to that of ours was reported by Junior RP et al [6]. But to the best of our knowledge this is the first case report of lithopaedion siamese twin pregnancy in medical literature.

 
   References Top

1.Costa SD, Presley J, Bastert G, Advanced abdominal pregnancy. Obstet Gynecol Surv. 1991; 46: 515-525.  Back to cited text no. 1    
2.Irick MB, Kitsos CN, O' Leary JA, Therapeutic aspects in the management of a lithopaedion. Am Surg 1970; 36: 232-234.  Back to cited text no. 2    
3.Frayer CA, Hibbert ML, Abdominal pregnancy in a 67 year old woman undetected for 37 years: a cases report. J Reprod Med. 1999; 44: 633-635.  Back to cited text no. 3    
4.Spiritos NM, Eisenkop SM, Mishell DR, Lithokelyphos: a case report and literature review. J Reprod Med 1987; 32: 43 - 46.   Back to cited text no. 4    
5.Bondeson J, The earliest known case of lithopaedion. J R Soc Med 1996 Jan; 89 (1): 13 - 18.   Back to cited text no. 5    
6.Junior RP, Knobel R, Parpinelli MA, Pereira BG, Amaral E, Surita FGC, calcified abdominal pregnancy with eighteen years of evolution: case report. Sao Paulo Med J/ Rev Paul Med 2000; 118(6): 192-194.  Back to cited text no. 6    

Top
Correspondence Address:
B K Bastia
M.K.C.G. Medical College & Hospital, Berhampur, Dist. Ganjam, Orissa-760 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32355

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

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