Conjoined twins: A report of four cases

Mohammed Hamada Takrouney, Ibrahim Ali Ibrahim, Hala Saad Abdel-Ghaffar, Ahmed Ibrahim Abdel-Wahhab, Mahmoud Mohamed Mostafa, Wesam Nashat Ali, Mohamed Sayed Abd-Elaal, Mohammed Hamada Takrouney, Ibrahim Ali Ibrahim, Hala Saad Abdel-Ghaffar, Ahmed Ibrahim Abdel-Wahhab, Mahmoud Mohamed Mostafa, Wesam Nashat Ali, Mohamed Sayed Abd-Elaal

Abstract

Background: Conjoined twin is a rarely seen congenital anomaly associated with significant morbidity and mortality. The most common types of conjoined twins are thoracopagus. Conjoined twins are either symmetrical twins or asymmetrical or heteropagus. This report records the successful separation of 2 cases of asymmetrical twins and one symmetrical twin with fused livers and diaphragm and communicating peritoneal cavities.

Patients and methods: This study amended and strictly followed the ethical guidelines of the Helsinki declaration, our study included 4 case reports on conjoined twins (CT), 2 male and three female patients; 3 of them were parasitic and one was conjoined. We operated upon 2 parasitics and one conjoined. The 1st case died preoperatively.

Results: Four living children is our result.

Conclusion: As connections between the bowel and bone of the parasite and the respective organs in the autosite are often absent, the parasite could be excised easily without any effect on the autosite. We recommend the separation of the parasite and the autosite as early as possible. In many cases, surgery results in the death of one or both of the conjoined twins, particularly if they are joined at the head or share a vital organ. Our separated twins are yet the youngest living separated twins.

Trial registration: ClinicalTrials.gov Identifier: NCT03388684.

Keywords: Conjoined twins; Heteropagus; Omphalopagus; Parasitic twins; Siame.

Copyright © 2020 Assiut University faculty of medicine. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Shows parasitic twins and the parasite was attached to the living one at the perineum posterior to the anus.
Fig. 2
Fig. 2
Epigastric heteropagus and the parasite was attached to the epigastric region midway between the xiphisternum and the omphalocele.
Fig. 3
Fig. 3
The parasite was connected to the host skin just above the host omphalocele and through it.
Fig. 4
Fig. 4
Xiphoomphalopagus conjoined twins conjoined by the sternum and supra-umbilical abdominal wall.

References

    1. Bondeson J. Dicephalus conjoined twins: a historical review with emphasis on viability. J. Pediatr. Surg. 2001;36:1435–1444.
    1. Carnevale F.C., Borges M.V., Affonso B.B., Pinto R.A., Tannuri U., Maksoud J.G. Importance of angiographic study in preoperative planning of conjoined twins: case report. Clinics (Sao Paulo) 2006;61(April(2)):167–170.
    1. Jackson O.A., Low D.W., Larossa D. Conjoined twin separation: lessons learned. Plast. Reconstr. Surg. 2012;129(4):956–963.
    1. Spencer R. Anatomic description of conjoined twins: a plea for standardized terminology. J. Pediatr. Surg. 1996;31(7):941–944.
    1. Gupta D.K., Lall A., Bajpai M. Epigastric heteropagus twins: a presentation of four cases. Pediatr. Surg. Int. 2001;17:481–482.
    1. Ribeiro R.C., Maranhaoa R.F., Moronb A.F., Leite M.T., Cordioli E., Hisaba W., Martins J.L. An unusual case of epigastric heteropagus twinning. J. Pediatr. Surg. 2005;40:39–41.
    1. Abubakar A.M., Ahidjo A., Chinda J.Y., Tahir C., Abubakar S., Adamu S.A., Pindiga U.H. The epigastric heteropagus conjoined twins. J. Pediatr. Surg. 2011;46:417–420.
    1. Spencer R. Parasitic conjoined twins: external, internal (fetuses in fetu and teratomas), and detached (acardiac) Clin. Anat. 2001;14:428–444.
    1. Kaniyil S., Pavithran P., Mubarak K.K., Mohamed T. Anaesthetic challenges in conjoined twins’ separation surgery. Indian J. Anaesth. 2016;60(November (11)):852–855.
    1. Agha R.A., Borrelli M.R., Farwana R., Koshy K., Fowler A., Orgill D.P., SCAREGroup The PROCESS2018 Statement: Updating Consensus Preferred Reporting Of CasE Series in surgery (PROCESS) Guidelines. Int. J. Surg. 2018;60:279–282.
    1. Mutchinick O.M., Luna-Muñoz L., Amar E., Bakker M.K., Clementi M., Cocchi G., da Graça Dutra M., Feldkamp M.L., Landau D., Leoncini E., Li Z., Lowry B., Marengo L.K., Martínez-Frías M.L., Mastroiacovo P., Métneki J., Morgan M., Pierini A., Rissman A., Ritvanen A., Scarano G., Eiffel C., Szabova E., Arteaga-Vázquez J. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. Am. J. Med. Genet. C Semin. Med. Genet. 2011;157C(4):274–287.
    1. . Youngest Ever Conjoined Twins Separated by Swiss Doctors at 8 Days Old. February 1, 2016 AT 10:26 AM Last Updated: February 1, 2016 3:24 pm.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться