Laparoscopic management of coexistent live ectopic pregnancy and lithokeliphopedion

Introduction/Aim A lithopedion is rare evolution of an undiagnosed and untreated advanced abdominal pregnancy in which the dead fetus is retained in the maternal abdominal cavity, with a consequent process of calcification. Like is well evidenced in literature, the incidence of abdominal pregnancy is around one in 11,000 pregnancies and lithopedions represent 1.5%÷1.8% of the evolution of these cases. It can originate from a primary abdominal pregnancy, an aborted tubal pregnancy, or an intrauterine pregnancy followed by uterine rupture. Most lithopedions are found incidentally, and no laboratory tests are currently able to make the diagnosis. Material and methods We receive at our gynecological/obstetric emergency unit a 32 year old patient that presented acute pelvic pain, uterine volume increased, serum beta-HCG: 4141 mUI/ml. After pelvic ultrasound, we set the suspected diagnosis of ectopic pregnancy, and prepared the patient for the surgery. During laparoscopic emergency surgery, we performed coagulation of a bleeding corpus lutetum in the left ovary, salpingectomy of the right fallopian tube in which there was the ectopic pregnancy, and after this we evidenced into the Douglas concave the presence of a hard spherical item that was sent for histological examination. Results The histological examination of the item evidenced a framework of ovular tissue with massive phenomena of coagulative necrosis, and confluent areas of calcification, referable to a “lithokelyphopedion” (a particular type of lithopedion). Conclusion What we observed intraoperatively allows us to hypothesize that the ectopic pregnancy occurred through an event of "internal migration" or "external migration" of the fertilized egg cell, that implants itself in the controlater fallopian tube respect to side of ovulation. Also peculiar is the observation of a lithokelyphopedion, a very rare case of abdominal pregnancy, occurred about two years before, coexistent with the observed ectopic live pregnancy.