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Lithopedion Causing Intestinal Obstruction

Riogi B1 MBChB, Odhiambo K1 MBChB, MMED (Surgery), Ogutu O2 MBCB, M.MED (O/G),PGDRM Affi liation: 1- Level 5 Kisii

Hospital 2-Department of Obstetrics & Gynaecology, University of Nairobi. Correspondence: Bahaty Riogi, MBChB, Department of

surgery, Kisii Level 5 Hospital, P.O Box 92-40200 Kisii, E-mail:

 

Summary

The formation of a mummified intra-abdominal pregnancy (lithopedion) is rare. A 25 year old Para 4 + 0 gravida 5 presented with features of intestinal obstruction and a four year history of an intra abdominal mass. Examination revealed a solid mass in the right upper quadrant. Ultrasound imaging showed a poor echo-calcified mass while an erect abdominal x ray revealed foetal bones within the abdominal cavity. At laparatomy a lithopedion with a normal uterus was found. Her last normal delivery was one year prior to this current presentation.

 

A lithopedion causing a mass effect (intestinal obstruction) and predating a normal intra uterine pregnancy followed by spontenous vertex delivery has not been reported in Kenya.

Introduction

Abdominal pregnancy accounts for up to 1.4% of all ec-topic pregnancy (1). It is usually associated with high morbidity and mortality. A large lithopedion is a rare obstetric phenomenon with less than 300 cases reported worldwide (2,3) . It occurs when a fetus dies during an abdominal pregnancy, is too large to be absorbed and instead calcifies to shield the mother from the dead tis-sues and infection. A case of a large lithopedion present-ing with intestinal obstruction has not been reported in Kenya.

 

Case Report

This is a case report of a 25 year old woman, Para 4 +0 gravida 5 who was referred to Kisii level 5 Hospital(KL5H) with a diagnosis of intestinal obstruction . She pre-sented with complaints of abdominal pain, constipa-tion, abdominal distension and vomiting for two days and a four year history of a non progressive abdominal swelling. On examination there was a large mass in the right upper quadrant, extending from the umbilicus to the epigastric region, hard in consistency, measured ap-proximately 20 by 20 cm, non tender, mobile with ill defined margins. Abdominal ultrasound revealed a poor e