Milestone surgery cures woman’s rare condition 

Mandera County Referral Hospital

The entrance to the Mandera County Referral Hospital. A medical team at the facility successfully performed a surgical operation to remove a 13-year-old “stone baby” from an Ethiopian woman’s abdomen.

Photo credit: File | Nation Media Group

What you need to know:

  • Lithopedion is a condition in which a fertilised ovum grows in the fallopian tube instead of implanting in the uterus. 
  • Ms Hawa Adan has had two deliveries before this condition and her medical history showed both babies died after birth.

For 13 years, Ms Hawa Adan, 31, lived with terrible stomachaches whose source remained a medical mystery even after shuttling from one hospital to the next.

After failing to get a proper diagnosis in their country, Ms Adan’s family, Ethiopians from Dholo, resolved to cross into Mandera in Kenya for help. 

Foreigners in parts of Ethiopia and Somalia near the Kenyan border often depend on Mandera for medical services.

Ms Adan arrived in Mandera in September and, after a medical exam including a CT scan, she was diagnosed with lithopedion.

Lithopedion is a condition in which a fertilised ovum grows in the fallopian tube instead of implanting in the uterus. 

Abdominal cavity

The fallopian tube only allows for the expansion of the foetus to a certain limit, beyond which it will either rupture or discharge into the abdominal cavity.

After her diagnosis, Ms Adan failed to show up for a scheduled surgical operation. After a month of trying to track her down, medics finally located her and brought her to the Mandera County Teaching and Referral Hospital accompanied by her husband last week.

A team of medics led by gynaecologist Abdi Maalim took about two hours to operate on Ms Adan, successfully removing the “stone baby” (ossified foetus).

Closer scrutiny revealed the foetus to be that of a male infant, complete with a placenta and umbilical cord, weighing 1.75kg. She is now recovering at the surgical unit of the hospital. 

She has had two deliveries before this condition and her medical history showed both babies died after birth.

“This is a very rare case and could be among the few in Eastern Africa,” said Dr Abdiaziz Sheikh, the lead surgeon.

According to an online medical journal by SpringerPlus, lithopedion is an extremely rare occurrence. Since the earliest case in 1582 in France, less than 300 cases have been reported.

Unable to conceive

Dr Sheikh explained that under such conditions, a woman’s menstrual cycle is regular except for a few instances. The patient often is unable to conceive, as was the case with Ms Adan.

Dr Sheikh said the patient reported occasional abdominal pains normally associated with the condition in the early stages. She also had a swollen womb just like any expectant mother.

“Physical examination revealed a lump in the right lumbar region, hard in consistency with restricted mobility and tender on movement. Laboratory work-up revealed no abnormal values,” said Dr Sheikh.

An X-ray of the abdomen and pelvis in erect posture revealed a radio-opaque shadow resembling a foetal skeleton in the right lumbar region. An ultrasound examination confirmed the calcified foetus that has been there for 13 years.

“Lack of the requisite technology in health facilities could be affecting diagnoses of the condition, but the medicl team in Mandera was able to identify her problem,” he said.

Dr Sheikh said that, due to the little size of the tubes that hinders the foetus growth, it (fallopian tube) ruptures and the foetus drops into the abdomen.

Once in the abdomen, Dr Sheikh said the foetus continues to grow but not to maturity as it dies.

He explained that, in Fatuma’s case, her body failed to reabsorb the foetus leading to calcification after about four months.

“The feotus was in the abdomen and covered by small intestines representing an oval-like mass weighing 1.75 kilogrammes,” he said.

Fatuma lacked the usual signs of discharge or bowel perforation after the operation and the team gave her a clean bill of health, Dr Sheikh said.

“We are surprised that, with 13 years of living this condition, the bowels were still intact and we managed to get the stone baby out without damaging them. It was a very successful surgery,” the surgeon said.

When opened, the sac-like covering had a foetus with well-developed arms and head. “It had the features of a baby boy when dissected,” Dr Sheikh said.

Mr Mohamud Adan Mohamed, the county executive committee member for health, said Mandera will continue shouldering the medical burden from Somalia and Ethiopia.

“We shall continue offering health services to our neighbours because we have the capacity unlike them. We’re proud of our medical staff and today’s successful operation is a sign that health services in Mandera County have come of age,” he said.

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