Thoracopagus: Autoptic and radiologic study of 2 cases

Conjoined twins are a very rare complication of monozygotic twinning, most common being thoracopagus. Here we report about two cases of thoracopagus male twins illustrating the autopsy details of one case and the prenatal magnetic resonance imaging (MRI) details of another case. While the first case was misdiagnosed as separate twins on antenatal USG, only to be later confirmed as thoracopagus twins after birth, the antenatal MRI done in the second case helped in accurate detection of thoracopagus twins. Bilateral peripheral cortical cysts with dysplasia was noted in one of the twins of the first case, which has not been reported earlier in conjoint thoracopagii. Early prenatal diagnosis of conjoined twins is essential for better counselling of parents regarding post natal surgical management or termination of pregnancy. Importance of prenatal MRI for accurate detection of these cases is thereby highlighted.

Anesthetic management for separation of thoracopagus twins with complex congenital heart disease: a case report / 대한마취과학회지

Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.

Diagnóstico precoz de gemelos toracópagos / Early diagnosis of Thoracopagus twins

Los gemelos toracópagos, xifópagos o esternópagos, representan el 75 % de los gemelos unidos simétricamente, están conectados por la región esternal o cerca de ella, situados cara a cara y habitualmente tienen órganos separados, excepto el hígado. Se presenta un caso de gemelos toracópagos con edad gestacional de 13,4 semanas, con el objetivo de demostrar el valor del ultrasonido en el diagnóstico precoz de los defectos morfológicos congénitos, describir los hallazgos anátomo patológicos y aspectos relacionados con la etiopatogenia de dichos gemelos.

Thoracopagus, xiphopagus or sternopagus twins represent 75% of symmetrically conjoined twins connected by the sternum or near, located face-to-face and usually they have separate organs except the liver. A case of Thoracopagus twins is reported in this paper. Their gestational age is 13.4 weeks. Our aim is to demonstrating the value of ultrasound in the early diagnosis of congenital morphological defects; to describe the pathological anatomic findings and issues related to the pathogenesis of these twins.

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.

A Rare Case of Syncephalus Thoracopagus Monster.

Conjoined twins are rare with an incidence of 1 in 1,00,000 to 2,00,000 births. They are always monozygotic and are more common in females (3:1). About 40 to 60 % are stillborn and another 35 % die within 24 hours after the delivery. We hereby Report a rare case Syncephalus Thoracopagus Monster.

Siameses: reporte de un caso

Se describe un caso de gemelos unidos, tipo toracópagos, con diagnóstico antenatal mediante ecografía. En una paciente de 14 años de edad, primigesta, se informó gestación gemelar variedad toracópago-xifópago de 23,4 semanas por ecografía. Ingresó al Hospital Madre-Niño San Bartolomé, donde se realizó cesárea corporal clásica más técnica B. Lynch, obteniendo recién nacidos vivos pretérmino toracópagos, sexo femenino. El diagnóstico se complementó con el estudio anatomopatológico confirmatorio. Se presenta el resumen de la historia clínica y el protocolo de necropsia.

A case of thoracopagus conjoined twins with ultrasound antenatal diagnosis is presented. Ultrasound study in a 14 year-old young mother in her first pregnancy revealed twin pregnancy variety thoracopagus-xiphopagus 23,4 weeks by biometry. She was admitted at Hospital Nacional Madre-Nino San Bartolome where classical corporal cesarean section plus B. Lynch technique were performed and female thoracopagus preterm live newborns were obtained. Pathology confirmed diagnosis. Summary of the clinical history and necropsy protocol are presented.

Thoracopagus conjoined twin - a case report.

A patient at her 38+ wks of pregnancy as a ultrasonographically diagnosed case of conjoined twin admitted in our department with ruptured membrane. Two live female babies joined at the chest were delivered by caesarean section. The parents refused a separation operation and the mother and the babies were discharged from hospital at 6th post natal day. A review of the literature suggests that early diagnosis by a combination of ultrasound and MRI is essential for management as it provides prognosis for viability and process of surgical separation and also the opportunity for early counseling of parents and termination if indicated.

A Case of Thoracopagus / 대한주산의학회잡지

The estimated incidence of conjoined twins is one in 50,000 births, however, over 60% are stillborn, making the observed incidence around one per 200,000 live-births. Thoracopagus is the most common variety of conjoined twins accompanying with congenital heart disease 75%, fusion of alimentary tracts 50%, single external biliary tract 25%. Approximately 90% of thoracopagus conjoined twins are not candidates for surgical separation due to the high degree of cardiac union and the complexity of cardiovascular anomalies. With improvement in prenatal diagnosis and routine ultrasound monitoring of pregnancies, these cases are more commonly being diagnosed prenatally. Accurate diagnosis of the shared anatomy and associated malformations is crucial for counseling of the affected families regarding outcome as well as planning potential postnatal surgical separation. We experienced a case of thoracopagus with single conjoined heart that was diagnosed by ultrasonography at 15 weeks of gestation in 33 years old woman. So we present this case with a brief review of literatures.

A Case of Thoracopagus / 대한산부인과학회잡지

Thoracopagus is very rare congenital anomaly with an incidence estimated at 1 in 50,000 deliveries or 1 in 600 twin deliveries. If twining is initiated after the embryonic disc and the rudimentary amnionic sac have been formed, and if division of the embryonic disc is incomplete, conjoined twins result. We experienced a case of thoracopagus in 28 years old woman. We present this case with a brief review of literatures.

Cross-sectional illustration on major types of conjoined twins

Conjoined twins show varying degree of conjoining in either facing or side-by-side fashion. Cephalothoracopagus janiceps is a prototype of facing anomaly in which the two bodies demonstrated a cross symmetry to the midline, that is axial symmetry. Interfacial and intersternal lines crossed at a right angle and no abnormality of situs was associated. Dicephalus dipus dibrachius is a case of side-by-side union, in which the bodies facing nearly the same direction were symmetrical to the middle sagittal plane. Abnormal situs of one was always associated. Other types of conjoined twins as thoracopagus lie between the two extremes of facing and side-by-side union. The three dimensional architectures of the organs in each type would be explained using cross sectional figures of skull, thorax and pelvis. Although the facing twins share the internal organs without fusion, the organs in the side-by-side component are fused with modification of the situs. We postulate sixteen pairs of situs and four manners of division for the explanation of the midline organs and the presence of a dominant co-twin. The splenic locations in a given cardiopulmonary situs are evaluated for the appraisal and applicability of these hypotheses.