BACKGROUND: Abdominal pregnancy is an exceedingly rare occurrence, but even
more unusual is prolonged retention of an advanced abdominal pregnancy wit
h lithopedion formation. We present the case of prolonged retention of an a
dvanced abdominal pregnancy in an elderly women.
CASE: A 67-year-old, white woman presented to the emergency department with
abdominal pain. Art acute abdominal series revealed It fetal skeleton exte
nding from the patient's pelvis to her lower costal margins. Pelvic examina
tion revealed a normal postmenopausal uterus, and human chorionic gonadotro
pin was negative. On further questioning the patient reported that she had
become pregnant 37 years earlier and was diagnosed Its having a "missed" pr
egnancy. She refused intervention at that tints but suffered no untoward co
nsequences. She reported having had later a healthy intrauterine pregnancy,
delivered vaginally at term. No attempt was made to remove the prior misse
d abdominal pregnancy. The acute pain episode resolved, and there was no su
rgical intervention.
CONCLUSION: Abdominal pregnancies can have a complex course, and management
decisions can be difficult. This case presents an unusual outcome of an ad
vanced abdominal pregnancy and illustrates a unique approach to management.