Lithopedion retained for 25 years presenting as partial intestinal obstruction in a postmenopausal woman: a case report

Lithopedion, which is a Greek word for “Stone child” is the name given to an ectopic pregnancy that evolves to fetal death, calcification, and carried for years. It is a very rare phenomena that are only about 300 cases of it registered in the history of lithopedion. A 50-year-old Ethiopian woman from Amhara region, Gravida 2, Para 1, came with complaints of abdominal pain and difficulty passing stool for 3 days. In addition, she had loss of appetite and weight loss. The patient had a history of admission to this same hospital for a prolonged pregnancy 25 years prior. On examination, there was abdominopelvic mass which was non-tender, hard but mobile. Cervix was closed and pushed posteriorly. The mass was palpable anterior to the cervix between symphysis pubis and cervix. Bedside ultrasound showed singleton pregnancy with cephalic presentation. No cardiac activity, and uterine wall could not be visualized separate from the mass. Intraoperative finding was dead stone fetus (lithopedion) encased in calcified, saponified adipose tissue in the peritoneal cavity. It was doubled up with head, buttock, legs, and arms visible but flexed at the buttock area. Adhesion bands released and lithopedion removed. The mother had smooth postoperative condition and discharged on day seven. This report details the successful surgical management of a 25-year-old lithopedion in a postmenopausal woman presenting with intestinal obstruction. It underscores the necessity for a high index of suspicion for rare pathologies in patients with a long-standing abdominal mass, especially in regions with limited historical access to healthcare. This case serves as a powerful reminder of the long-term sequelae of untreated ectopic pregnancies and the importance of patient education and accessible surgical care.