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BACKGROUND: Abdominal pregnancy is defined as pregnancy anywhere within peritoneal cavity exclusive of tubal, ovarian or broad ligament. It can be primary or secondary (more common). It represents 0.9-1.4% of all ectopic pregnancy with incidence of lithpedion being 1.5-1.8% of all extrauterine pregnancies.
CASE REPORT: Unbooked case of 28 year, P2L1D1, presented as a 3rd day postnatal case with vaginal delivery and second retained fetus in abdominal cavity. She had features of acute abdomen. She was pale with abdomen grossly distended with ascites. Ultrasonography suggested abdominal ectopic in left lumbar region. CT Angiography revealed calcified fetus with small calcified mass of 3*3 cm attached near cornu of uterus which might be placental tissue. After stabilizing the patient, laparotomy was planned with multidisciplinary team. Intra-op findings include stone baby (lithopedion) present in lower abdomen wrapped in omentum suggestive of calcified fetus of 26 weeks size and a small calcified mass attached to rudimentary anlagen on right side of uterus with no internal communication with uterus. She was discharged on 8th day of post op recovery in good condition.
CONCLUSION: Proper antenatal care and early diagnosis of ectopic/ heterotopic pregnancy is required for management as such cases which can present later with high incidence of maternal mortality and morbidity.
This was a special case of heterotopic pregnancy. Intrauterine pregnancy delivered vaginally while secondary abdominal pregnancy retained as lithopedion which is a very rare phenomenon. This occurred as the case was undiagnosed for a long time which resulted in calcification of dead fetus without autolysis. Maternal mortality can be reduced with multidisciplinary approach in management of such patients.
