A rare case of dicephalic parapagus conjoined twins

Dicephalic parapagus are one of the rare forms of conjoined twins. Their prognosis is usually very poor. Early prenatal diagnosis of these serious congenital abnormalities remains a real challenge for health systems in the low-income countries. The late antenatal diagnosis of a case of this abnormality was presented. The diagnosis was made at the 33rd week on the only ultrasound performed during the pregnancy. The pregnancy was interrupted with the agreement of the couple and delivery was performed by caesarean section.

A rare case of conjoined twins presenting as dicephalus parapagus: a case report

Conjoined twinning is a congenital abnormality resulting in various presentations of the fetuses in utero. It is a rare embryological developmental disorder occurring in one in 100,000 births. We present a case of conjoined twinning, which is characterized by the presence of two heads, single vertebral column and single symphysis pubis, with single genitor-urinary tract and single gastro intestinal tract. The present condition, referred to as dicephalus parapagus, is a rare entity among the conjoined twinning and has seldom positive outcomes. The mechanism of occurrence of conjoined twinning has been proposed either through fusion or fission of the embryos. In either case, surgical separation of the conjoined twins is often unsuccessful and results in increased morbidity and mortality. However, it is essential to screen for the presence of such congenital anomalies early during pregnancy, in order to terminate and provide parental counselling.

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.

A Case of Conjoined Twins / 영남의대학술지

Conjoined twinning is a rare congenital malformation, accounting for 1% monozygotic twins. Conjoined twins result if twining is initiated after the embryonic disc and rudimentary amniotic sac have been formed and if division of the embryonic disc is incomplete. Recently we experienced a case of conjoined twins, dicephalus dipus dibrachius, who had died at 3 hours of life, and performed autopsy. Autopsy revealed a total duplication of the heads, spines up to sacrum, small bowels, thymus and lungs. Two hearts existed within a common pericardium.

Dicephalus bipus tetrabrachius twinning report of a case.

This is a report of conjoined twins, Dicephalus Bipus. Tetrabrachius variety which are particularly rare. The diagnosis was suspected antenatally on the basis of radiologic criteria. They were delivered by caesarean section and died 4 hours after because of respiratory insufficiency. Clinical features, embryogenesis, diagnosis modalities and management of conjoined twins are reviewed in detail.