A 72-year-traditional woman in Senegal died after a previously undiagnosed, full-term pregnancy resulted in a calcified fetus, known as a lithopedion, perforating her small intestine. The case, described by doctors at Aristide Le Dantec Hospital in Dakar in an article published in the Journal of Forensic Sciences in May 2022, is unusual due to the discovery occurring post-mortem.
The woman initially presented to the emergency room complaining of severe abdominal pain. She reported being struck in the abdomen during an altercation with her son-in-law. Doctors performed an ultrasound to assess for internal injuries. The scan revealed a large, calcified mass in her abdomen. Due to financial constraints, a follow-up CT scan, which was recommended, was not performed.
Unable to secure a hospital bed due to the ongoing Covid-19 pandemic, the patient was discharged with pain medication. Two days later, she was found dead at her home. Police requested an autopsy to determine the cause of death.
The autopsy revealed no external signs of trauma consistent with the reported assault. However, internal examination revealed half a liter of pus within the abdominal cavity and a perforation of the distal ileum, the final section of the small intestine. Crucially, the autopsy also discovered a calcified fetus, a lithopedion. This condition occurs when a non-viable pregnancy, originating as an ectopic pregnancy in the fallopian tube, fails to be expelled from the body and undergoes calcification.
The lithopedion, measuring 15 centimeters in length and weighing 750 grams, was located above the patient’s umbilicus. Analysis of the fetal femur indicated the pregnancy had reached 37 weeks of gestation, equivalent to the beginning of the ninth month. The patient, married for over 30 years, was unaware she was pregnant.
Doctors determined the lithopedion indirectly caused the woman’s death. The blow to her abdomen dislodged the dense, calcified mass, causing it to perforate the intestinal wall. This perforation led to peritonitis and her death. The death was classified as a homicide, stemming from the initial assault.
Forensic thanatological activities in Dakar are primarily conducted at Aristide Le Dantec Hospital and the General Hospital of Grand Yoff, according to a study published in ScienceDirect. The Aristide Le Dantec Hospital also houses the Orthopaedic-Traumatology Department, where research on complications of total hip prostheses, and their forensic implications, has been conducted.