A 26-Year-Old Retained Demised Abdominal Pregnancy Presenting with Umbilical Fistula

This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient’s condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day. 1. Introduction Abdominal pregnancy is a rare form of ectopic pregnancy where the conceptus implants in the abdominal cavity [1]. This is mostly a result of reimplantation of ruptured undiagnosed tubal ectopic pregnancy [2]. The highest incidence in the world is found among the South African Bantu tribes, where it accounts for 2.2% of all ectopic pregnancies [3]. In Sokoto, Nigeria, an incidence of 3.1/10,000 deliveries has been reported, while in the United States of America (USA), it occurs in 1 in 3372 to 7931 pregnancies [4, 5]. Diagnosis of abdominal pregnancy presents a dilemma to many physicians, because the presenting symptoms are variable. A high index of suspicion is the cornerstone to diagnosis and early diagnosis is necessary to improve prognosis. Maternal mortality is very high and it is usually due to severe intraabdominal hemorrhage and sepsis [4]. The fetal prognosis is also very poor due to friability and poor vascularity of the placental implantation site, resulting in fetal growth restriction and fetal anomalies [4]. In situations where the fetus has demised, it may be retained and undergo mummification particularly when the pregnancy is advanced and abdominal pregnancy has been undiagnosed. We present a case of a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula as a result of a demised abdominal pregnancy which had been retained for 26 years (Figure 1). Figure 1: Umbilical fistula. 2. Case Report The patient was a 72-year-old Para 4A2 widow from Sokoto, Nigeria, who was 26 years postmenopausal. She was referred from the surgical outpatient clinic (SOPD), with a 2-week history of passage of bony substances suspected to be fetal bones through the umbilicus (Figures 2 and 3). There was a preceding one-year history of purulent discharge from the umbilicus. The discharge was occasionally bloody and she noticed three pieces of bone drop spontaneously from the discharging point. There was no antecedent trauma or surgical procedures on the abdomen. She had no history of vaginal bleeding or discharge. She was pregnant before