ABSTRACT
Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical separation of conjoined twins is extremely risk of death and life threatening. We report on cases of female pygopagus twins of three months operated and separated at Kigali University Teaching Hospital. For both babies a posterior sagittal anorectoplasty was successfully performed with derivated ileostomy. Despite limited resources to carry out such operation in our settings; no complications occurred during the operation and oral feeding was done at third postoperative day. Ileostomy closure was performed three weeks after and babies were discharged from neonatology unit at 35th postoperative day. In conclusion; adequate preoperative investigation with a well organized and trained team contribute a lot to the success of such conjoined twins separation