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Monday, September 08, 2014

Babies that Turn to Stone: Meet the Lithopedions

Stone Baby from 1897

Earlier this year, an 84-year old woman in Brazil was found to have a 44-year-old fetus inside her (of 22 to 28 weeks gestation). The fetus had become calcified to protect the mother from the fetus’s dead tissue and possible infection. The calcified fetus is known as a Lithopedion, which is Greek for “stone child.” Lithopedions are commonly referred to as Stone Babies. They occur when a fetus develops outside of the womb, dies, is too large to be absorbed by the body, and calcifies inside the abdomen when medically undetected.

Stone Babies are extremely rare, occurring in 0.0054% of all pregnancies.One is pictured above from 1897 (copyright Bulletin of the Johns Hopkins Hospital).

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Women who carry a calcified fetus for decades generally do so unknowingly, as incredible as this may sound. See the case from 1677 discussed at the end of this article, for an exception. Although a Stone Baby can develop from any time between 14 weeks and full-term, the larger it is the more likely it is to be discovered. Age of diagnosis in the mother of a Stone Baby can vary across the life span, from 20 to 100 years.

Women can have additional future uncomplicated pregnancies while the Stone Baby is present because the uncomplicated pregnancy develops inside the womb unlike the presence of the Stone Baby outside of the womb.  However, the presence of a Stone Baby has been known to interfere with fertility by distorting the structure of the pelvis, impairing the pick-up of the egg cell.

While such women can have stomach pains from the calcified fetus, the pains usually go away at some point or are intermittent and can improve with pain medication. If the woman seeks medical care and an imaging study (e.g., x-ray) is not performed, then the real source of the problem goes undetected. If imaging is performed, a Stone Baby or a tumor may be suspected. Stone Babies are more common in counties where there is limited access to healthcare and in settings where health care providers are unaware of their existence. 

Various features of Stone Babies, including the face, can still be recognized even 44 years later. A 40-year-old Stone Baby was discovered in 2013. The oldest Stone Baby known was 60-years-old, found inside a Chinese woman in 2009. The youngest was less than 18 months in 2014. Ultimately, surgery is needed to remove it.

Fewer than 300 cases of Stone Babies have been reported in the past 400 years of medical literature, although the Arabic physician, Albucasis, described one for the first time in the 10th century. The earliest known Lithopedion dates to 1100BC. The first “modern” reported case dates back to 1582 when a 68-year-old French woman named Madame Colombe Chatri was found to have had a 28-year-old Stone Baby. Early physicians used to think that the cause of Stone Babies was a mystical force as they had not yet developed the scientific knowledge to explain their development.

In 1880, the German physician, Friedreich Kuchenmeister, published a review of 47 cases of Lithopedions, beginning in 1582. However, he missed a case from 1677, which is now summarized and referenced below. The case involved a Lithopedion that remained in the mother (Margaret Mathew) for 26 years. She was in the 9th month of her pregnancy and her water broke, but the baby did not come forth. Over the next 20 years, she had the perception that the child was still inside of her along with unspecified “troublesome symptoms.” She desired a surgeon to open her abdomen and relive her of the problem. However, over the next six years, she did not perceive the child to move.

The woman eventually passed away at age 64 and the surgeon then opened her abdomen. At this point, the Stone Baby was discovered, weighed 8 pounds, was 11 inches long, and was not joined to the mother. The head was downward and the skull was broken into several pieces. The brain and the flesh was red or yellow. The tongue was pink. The heart was red but contained no blood. The inner organs were blackish, The back part of the child was covered with a membrane that could only be separated with a knife. When this was done, barely any blood came forth. The forehead, eyes, ear, and nose were covered with a callous substance. The teeth were like those of an adult. Three days after it was removed, no bad smell was noted.

Reference: Bayle, M. (1677). A Relation of a Child which Remained Twenty Six Years in the Mothers Belly. Taken out of the Journal Des Scavans; Being the Extract of a Letter Written from Tolouse 22. June to the Author of That Journal, by Monsieur Bayle, M.D. Philosophical Transactions, 139, 979-980.

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