lithopedion lithopedion 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, 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. lithopedion, lacking facial features, with calcification of the placenta and soft tissues a lithopedion. this highly unusual specimen remained in the abdomen of a woman for 2 years lithopedia may occur from 14 weeks gestation to full term. it is not unusual for a stone baby to remain undiagnosed for decades and to be found well after natural menopause; diagnosis often happens when the patient is examined for other conditions that require being subjected to an x-ray study. a review of 128 cases by t.s.p. tien found that the mean age of women with lithopedia was 55 years at the time of diagnosis, with the oldest being one-hundred years old. the lithopedion was carried for an average of 22 years, and in several cases, the women became pregnant a second time and gave birth to children without incident. nine of the reviewed cases had carried lithopedia for over 50 years before diagnosis. according to one report there are only 300 known cases of lithopedia recorded 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 percent of these abdominal pregnancies may develop into lithopedia. history a ct scan showing an extra-uterine calcified foetal skeleton, a lithopedion 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 may have been found in a gallo-roman archaeological site in costebelle, southern france, dating to the 4th century. 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 caesarean section. an archeological team did a "differential diagnosis of a calcified cyst found in an 18th century female burial site at st. nicholas church cemetery" in czechia and determined the mass was likely either a case of lithopedion or fetus in fetu. 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 child"), where both fetus and sac are calcified. lithopedia can originate both as tubal and ovarian pregnancies, although tubal pregnancy cases are more common. reported cases before 1900 patient(age at time of diagnosis) location date of pregnancy date of diagnosis (case duration) additional information unknown cordoba, ii umayyad caliphate unknown late 10th century the case referred by abulcasis. the patient was pregnant in two separate occasions but never gave birth. "a long time" after, she developed a large swelling in the navel area, that turned into a suppurating wound and would not heal despite receiving treatment. this continued until abulcasis removed several fetal bones through the wound, which initially shocked abulcasis, as he had never known of a similar case. the patient largely recovered her health, but she continued to suppurate through the wound. lodovia "lacavalla" pomponischi, duchy of mantua unknown 1540 the patient had a failed pregnancy followed by a successful one, after which she fell sick and rapidly lost weight. christopher bain, a travelling surgeon, practised an incision and extracted "the skeleton of a male child". she recovered fully and went on to have four more children. colombe chatri (68)* sens, kingdom of france 1554 1582 (28 years) chatri became pregnant for the first time at 40, but never gave birth after breaking her water and going through labor pains. she was bedridden for the next three years, during which she noticed a hard tumor on her lower abdomen, and complained of tiredness and abdominal pains for the rest of her life. after her death, her widower requested two physicians to examine her body, who discovered a fully formed, petrified baby girl, with remains of hair and a single tooth. by 1653 the lithopedion had come into the possession of king frederick iii of denmark, who consented to show it to thomas bartholin, but not to examine it further. unknown pont-à-mousson, lorraine, holy roman empire 1629 1659 (30 years) unknown dôle, franche-comté, spanish empire 1645 1661 (16 years) marguerite mathieu (62)* toulouse, kingdom of france 1653 1678 (25 years) originally from the gascon village of viulas near lombez, mathieu gave birth to ten children but only three survived infancy. at 37, she became pregnant, carried to full term and broke her water for the eleventh time, but never gave birth despite the efforts of a physician. she suffered from acute abdominal pain for two months, vaginal bleeding for five months, and felt discomfort for the rest of her life. this only eased when she laid on her back, making her bedridden and she experienced periodic paroxysmal attacks. her case became notorious and her symptoms were popularly attributed to a spell cast by a sorceress whom mathieu had rejected as a midwife. she consented to a public, three-day long necropsy after her death, which was attended by four doctors, three surgeons and their assistants. they found the calcified umbilical cord, placenta and a fully formed baby boy inside that weighed 3,916 grams (8 lb 10 oz). the lithopedion was found floating in white, odorless pus, which made it semi-mobile and would explain mathieu's claim that she could still feel the baby moving inside her. the lithopedion was extensively described and pictured in a published memoir by françois bayle, one of the doctors present. unknown leeuwarden, united provinces c. 1692 1694 (21 months) a 21-month-old, intra-tubarian lithopedion was removed successfully from a living woman by cyprien, a teacher of anatomy and surgery at the university of franeker. anna mullern (94)* leinzell, swabia, holy roman empire 1674 1720 (46 years) aged 48, mullern became pregnant, broke her water and went through labor pains for seven weeks without giving birth, retaining a swollen belly afterwards. she would suffer pain when exercising for the rest of her life, but she was able to become pregnant again and gave birth to healthy dizygotic twins. convinced that she had been pregnant and carried the previous baby with her still, mullern made the local physician and surgeon swear that they would open her body after her death. the physician did not survive her, but the elderly surgeon fulfilled his promise with the help of his son, finding "a hard mass of the form and size of a large ninepin-bowl" that contained a petrified fetus inside. it was examined by george i of britain's personal physician johann georg steigerthal, who wrote an account of it. marie de bresse (61)* joigny, kingdom of france 1716 1747 (31 years) patient was in her second pregnancy after a natural abortion four years before. de bresse took it to full term and underwent labor pains for two days, but never had vaginal dilatation. after the midwife gave up, an assembly of doctors and physicians from troyes decided unanimously that the best was to perform a cesarean section, but she refused. she continued having abdominal pains for a month and could not resume work before eight. she never regained her period and continued lactating for thirty years. at 61, she was hospitalized for chest inflammation and died shortly after. the autopsy found an oval mass the size of a man's head embedded in her right fallopian tube, which weighed 8 pounds (3.6 kg) and contained a fully formed baby boy with hair, two incisors and remains of amniotic fluid. the envelope was not fully calcified. mrs. ball london, kingdom of great britain 1741 1747 (6 years) "a dead infant" was found in the belly, outside of the womb, during an autopsy performed at the request of the patient. in the time between her failed pregnancy and her own death, ball became pregnant and gave birth four times without complications. randi jonsdatter (50) kvikne, hedmark, denmark-norway 1803 1813 (10 years) patient "gave birth" to a petrified baby divided in two parts, through a cut performed over jonsdatter's belly button. she lived for many years after without any further problems. rebecca eddy (77)* frankfort, new york, united states c. 1802 1852 (c. 50 years) aged 27 and in her first pregnancy, eddy went through what seemed to be labor pains after an accident with a large kettle over the fire, but the pains disappeared a few days later and she never gave birth. william h. h. parkhurst examined her in 1842, noting the "largeness, hardness and irregularity" of her abdominal lump; he would perform her autopsy in front of 20 witnesses when she died a decade later. during the process parkhurst found "a perfect formed child... weighing 6 pounds avoirdupois (2.7 kilograms)" who "had no adhesions or connections with the mother except to the fallopian tubes, and the blood vessels which nourished it, and which were given off from the mesenteric arteries... the child was almost floating in the abdomen." sophia magdalena lehmann (87)* zittau, german empire 1823 1880 (57 years) lehmann, a widow from olbersdorf, was diagnosed with lithopedion in 1823 by an obstetrician in zittau, and treated by küchenmeister before he moved to dresden in 1859. upon her death, küchenmeister performed her autopsy and used her case to describe the lythokeliphos category. * after death of the patient. after 1900 patient(age at time of diagnosis) location date of pregnancy date of diagnosis (case duration) additional information mrs. c (31) london & devon, great britain jan–june 1929 (presumed) 1930-02-24 (seven months) "skiagram confirmed...the fœtus was lying among coils of small intestine" unknown yazoo city, mississippi, united states c. 1930 1933 (c. 2–3 years) while performing surgery to remove a tumor on a woman from inverness, mississippi, dr. l.t. miller discovered the lithopedion "that had become petrified to the right of the tumor." unknown (54) jamaica 1957 1966 (9 years) the patient, who had given birth previously, had a swollen belly and noted movement inside, but did not believe she was pregnant because she continued to menstruate, albeit irregularly. the movements ceased shortly after being admitted to a kingston hospital but the bleeding and pain continued until she was operated on 8 months later. although her belly had deflated, the patient still felt a mass inside, but was dismissed by her doctor. the pain resumed years later, when the woman had migrated to toronto, ontario, canada, and she was relieved of an oval-shaped, calcified mass of 8 × 4 x 3 cm. unknown (60) thailand 1959 1987 (28 years) a 60-year-old woman presented with an abdominal mass that she had had for 28 years, with no additional symptoms being reported. scans revealed the nature of the mass to be a lithopedion. surgical removal yielded a well-preserved calcified dead foetus weighing 1060 grams and the patient recovered uneventfully. unknown (76) republic of china 1950 1999 (49 years) patient was originally diagnosed with a benign tumor in 1950, but refused the operation to extract it. unknown (67) washington, united states 1962 1999; not extracted (37 years) admitted with abdominal pain, the patient reported to have "missed the baby" during a pregnancy 37 years prior, but refused intervention. she suffered no consequences and carried a second intrauterine pregnancy to term with no problem. pain episode resolved and patient released without attempt of extraction. unknown (40) campinas, são paulo, brazil 1982 2000 (18 years) the "patient reported regular abdominal growth and healthy fetal activity from a pregnancy that happened 18