Conjoined twins: report of two cases and review of literature.

Two pairs of conjoined twins were encountered at the SCB medical college cuttack, Odisha, India during the past 3 years. In the first set the prenatal diagnosis was not established and the case was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Emergency caesarean section done and a pair of thoraco-omphalopagus twins delivered. Both babies died soon after birth. In the second case the conjoined twins were diagnosed prenatally at 20 weeks of gestationon in routine anomaly scan as thoraco-omphalopagus twin with fetuses were positioned face-to-face and fused from sternum to umbilicus. Fetuses were found to have separate hearts, a fused liver and separate upper and lower gastrointestinal tracts. Each twin had two normal appearing kidneys and a urinary bladder. The couples were counselled about the various management options and referred to higher centre. But she was admitted at 34 weeks of gestation with preterm labour and emergency caesarean section done and a pair of male thoraco-omphalopagus twins delivered. Both babies were alive and referred to higher centre for further management. The prenatal identification of conjoined twins is of cardinal importance for the planning of delivery and possible separation.

Conjoined twins: twenty years' experience at a reference center in Brazil

OBJECTIVE: This study reports on the experience of one hospital regarding the surgical aspects, anatomic investigation and outcomes of the management of 21 conjoined twin pairs over the past 20 years. METHODS: All cases of conjoined twins who were treated during this period were reviewed. A careful imaging evaluation was performed to detail the abdominal anatomy (particularly the liver), inferior vena cava, spleen and pancreas, either to identify the number of organs or to evaluate the degree of organ sharing. RESULTS: There were eight sets of ischiopagus twins, seven sets of thoracopagus twins, three sets of omphalopagus twins, two sets of thoraco-omphalo-ischiopagus twins and one set of craniopagus twins. Nine pairs of conjoined twins could not be separated due to the complexity of the organs (mainly the liver and heart) that were shared by both twins; these pairs included one set of ischiopagus twins, six sets of thoracopagus twins and one set of thoraco-omphalo-ischiopagus twins. Twelve sets were separated, including seven sets of ischiopagus twins, three sets of omphalopagus twins, one set of thoracopagus twins and one set of craniopagus conjoined twins. The abdominal wall was closed in the majority of patients with the use of mesh instead of the earlier method of using tissue expanders. The surgical survival rate was 66.7%, and one pair of twins who did not undergo separation is currently alive. CONCLUSION: A detailed anatomic study of the twins and surgical planning must precede separation. A well-prepared pediatric surgery team is sufficient to surgically manage conjoined twins.

Siameses / Siamese

Introducción: el nacimiento de siameses es siempre un evento raro e inevitablemente ha deslumbrado a especialistas y personas ajenas a la Medicina. las primeras siamesas Mery y Eliza fueron reportadas en el año 1100. Objetivo: exponer el primer caso reportado en Cuba en el 1er. trimestre del embarazo. Paciente: se reporta un caso de siameses onfalópagos diagnosticado en el 1er. trimestre del embarazo en el Centro Municipal de Genética de San Miguel del Padrón. Se detectó incremento de la translucencia nucal en ambos gemelos y defecto de cierre del tubo neural en uno de ellos, en el municipio. En el nivel terciario se confirman estos marcadores y se detectan alteraciones del flujo del ductus venoso en ambos fetos. El estudio citogenético informó fetos cromosómicamente normales. Se interrumpe el embarazo a las 17 sem. Resultados: el estudio anatomopatológico confirmó la presencia de siameses onfalópagos, de sexo femenino. Ambos fetos compartían hígado y porción de intestino delgado. Se observó riñón izquierdo hipoplásico en el primer feto. El segundo gemelo presentó defecto del tubo neural, mielomeningocele sacrococcígeo y agenesia de sínfisis del pubis. Conclusiones: se comprueba la eficacia del programa cubano para la detección temprana de malformaciones congénitas

Introduction: conjoined twins are always a rare event, and inevitably it has puzzled specialists and people outside of medicine. The first Siamese Mery and Eliza were reported in 1100. Objective: to describe the first case reported in Cuba in the 1st. trimester of pregnancy. Patient: It is reported a case of omphalopagus conjoined twins diagnosed in the 1st. trimester of pregnancy in the Municipal Center of Genetics, San Miguel del Padrón. in the township consultation, we detected increased nuchal translucency in both twins, as well as defects in neural tube closure in one of them. At the tertiary level of care, these markers are confirmed, and changes in the venous ductus flow on both fetuses were detected. The cytogenetic study reported chromosomally normal fetuses. This pregnancy was interrupted at 17 weeks. Results: the pathologic study confirmed the presence of female omphalopagus conjoined twins. Both fetuses shared liver and a portion of small intestine. Hypoplastic left kidney was observed in the first fetus. The second twin presented neural tube defect, myelomeningocele and sacrococcygeal agenesis of the symphysis pubis. Conclusions: the effectiveness of the Cuban program for early detection of congenital malformations is confirmed

Diagnóstico muy precoz de siameses: caso clínico y revisión de la literatura / Early diagnosis of conjoined twins: clinical case and literature review

We report a clinical case in which an early ultrasound diagnosis of retained abortion of thoracoomphalopagus siamese twins is performed by embryonic biometry at 9.5 weeks of gestation. 2D and 3D images clearly illustrate the condition and the accuracy of prompt diagnosis of a disease with such a low prevalence among the world population.

Se reporta caso clínico en el cual se realiza el diagnóstico ecográfico precoz de aborto retenido de siameses tóraco onfalópagos de 9 1/2 semanas por biometría embrionaria. Destacables son las imágenes 2D y 3D que ilustran claramente la condición y la precocidad del diagnóstico de una patología tanpoco prevalente en la población mundial.

Management of Anesthesia for Xipho-omphalopagus Twins: A case report / 대한마취과학회지

The birth of conjoined twins remains an extremely rare event. Most of such twins are stillborn and one third of the live births die within first day of life. In Korea, there are only three reports on the anesthesia for separation of different kinds of conjoined twins. In view of anesthesia for separation of such twins prematurity, low birth weight, and anomalous shared organ play the major role on the perioperative morbidity and mortality. Such anesthesia therefore is one of the exceedingly complex fields among the pediatric anesthesia and require mobilization of all possible methods and monitoring devices used for pediatric anesthesia. We performed careful preoperative evaluation of extent of joining, discussion and rehearsal of separation procedure between separation team, and anesthetic care such as all possible monitoring, preservation of body temperature, appropriate fluid therapy, awake intubation, avoid neuromuscular blockers, and thorough separation of duty. The separated twins showed normal weight gain postoperatively and discharged postoperative 31th day without any complications.

A case of Conjoined Twins: Omphalopagus

Conjoined twins are one of the rarest and most challenging congenital anomalies in pediatric surgery. Successful surgical separation is more unusual, since the majority of conjoined twins are incapable of separating successfully. The timing of separation is variable, but separation is usually delayed until such infants are relatively mature (i.e, 9-12 months of age). Operative survival was 50% in those operated on in the neonatal period, but 90% in those of over 4 months of age. Our case was early separated beacase of one of the twins having heart problems. These twins were omphalopagus and shared only simple liver bridge without vascular and biliary communications. Surgical separation was undertaken successfully on the 11th day of life, so we describe our experience with the review of the relevant literatures.

A Case of Conjoined Twin / 대한주산의학회잡지

Conjoined twins occur when there is imcomplete fission of the inner cell mass later at approximately 13 to 15 days after fertilization. The earlist case in the literat.ure appears to be that of the Biddenden Maids who were born in England in 1100. since then over two hundred cases of successful separation were reported on literature. And also successful separation cases were reported by Seung et al.(1991) in Korea. Conjoined twins occur between one in 50,000 to 100,000 births but real incidence is one in 200,000 because two thirds are stillbirth or died immediately after birth. The conjoined twins are not associated with maternal age, race or family history and 70 % of them are females. We experienced a case of conjoined twins with omphalopagus and performed surgical separation. A brief review of related literatures was done.