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.