Lithopedion in a 74-year-old woman: a rare sequela of undiagnosed abdominal pregnancy – case report

Introduction and importance: Lithopedion (Greek for "stone baby") is an extremely rare complication of undiagnosed abdominal pregnancy where a dead fetus becomes calcified and retained for decades. This phenomenon demonstrates both a unique obstetric event and global disparities in prenatal care access. Case presentation: A 74-year-old post-menopausal woman presented with vague abdominal discomfort. Imaging revealed a calcified mass resembling a fetal skeleton in the pelvic cavity. Her obstetric history indicated a pregnancy several decades earlier with reported intrauterine fetal death that went unmanaged due to limited medical access. Laboratory results were normal. CT imaging confirmed a densely calcified fetal structure adjacent to the uterus without surrounding inflammation. Considering her age and asymptomatic status, conservative management with regular follow-up was chosen. Six months later, she remained stable and free of symptoms. No calcified placenta or adnexal structures were identified, helping rule out alternative differential diagnoses such as calcified fibroids or teratomas. Clinical Discussion: Lithopedion forms when a dead fetus remains sterile and too large to be reabsorbed, prompting the body to encase it in calcium for protection. Most cases remain asymptomatic and are discovered incidentally in older women during imaging. Management must be individualized, balancing surgical risk and patient preference. Conclusion: This case underlines the importance of early recognition of ectopic pregnancies, the role of imaging in diagnosis, and improved access to obstetric care. This case strongly emphasizes the role of maternal health care access, imaging availability, and timely diagnosis in preventing long-term sequelae such as lithopedion.