Usually, when pathogenic micro-organisms gain access to the gestation-sac the fœtus decomposes, and fistulæ form, by which pus, accompanied by fragments of fœtal tissue and bones, finds an exit and affords evidence of the nature of the case. These fistulæ may open into the rectum, bladder, vagina, uterus, or some spot on the anterior abdominal wall below or near the umbilicus. The treatment is simple, and consists in dilating the sinus and extracting all the fragments. If this be thoroughly carried out the sinus quickly closes. Partial operations are useless: if but a bit of a bone remain, a troublesome sinus will persist. It is bad practice to attempt to extirpate the sac in such condition; such an operation usually terminates fatally.
In a case of old-standing lithopædion it is unusual to find any trace of the placenta. J. W. Smith operated on a woman in whom a lithopædion had caused intestinal obstruction. The fœtus had probably been retained 15½ years, and the placenta was represented by a calcified encapsuled ball, with an average diameter of 6 cm.
Results of operative treatment. In order to afford some notion of the risks attending the surgical treatment of extra-uterine gestation, as well as to give an idea of its relative frequency in hospital practice, the following figures will serve. From 1896 to 1907, both years inclusive, 116 operations were performed for extra-uterine gestation in the Chelsea Hospital for Women. During this period all the varieties of tubal pregnancy were encountered (ampullary, isthmial, tubo-uterine), including the rare condition of a full-time living fœtus free among the intestines, and the more uncommon condition of a full-time cornual pregnancy. There were four deaths in the series, one in 1897, 1902, and two in 1905. Death in the fatal cases was attributed to pulmonary embolism, peritonitis, and in two to heart failure.
A Table showing Cases of Concurrent Intra- and Extra-uterine Pregnancy (Compound Pregnancy) running to Term, with the Fate of the Mother and Children.
| Recorder. | Year. | Fate of Mother. | Intra-uterine Child. | Extra-uterine Child. |
|---|---|---|---|---|
| Cooke | 1863 | Died | Died | Died |
| Sale | 1871 | Died | Lived | Lived |
| Wilson | 1880 | Died | Died | Lived |
| Galabin | 1881 | Died | Died | Died |
| Franklin | 1893 | Died | Lived | Died |
| Matthewson | 1894 | Lived | Lived | Killed 1 |
| Ludwig | 1896 | Lived | Lived | Lived |
| Allardice | 1905 | Lived | ? | Dead 2 |
| Menge | 1907 | Lived | Lived | Lived |
1 This fœtus was killed by means of a stilette passed through the abdominal wall of the mother into its thorax. The patient had two subsequent confinements without difficulty. In 1898 the ‘lump’ had shrunk, but was movable and caused no difficulty. Pacific Medical Journal, September, 1898.
2 Intra-uterine child born naturally at the seventh month. Extra-uterine fœtus died, set up septic changes, and was removed by cœliotomy some weeks later.
References
Leopold. Ovarialschwangerschaft mit Lithopädionbildung von 35-jähriger Dauer. Arch. f. Gyn., 1882, Bd. xix. 210.
Menge. Eine reine Ovarialschwangerschaft mit bebendem Kinde. Vide Fränkische Gesellschaft für Geburtshülfe and Frauenheilkunde. Münch. med. Wochensch., 1907, liv. 2452.