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Freitas K, Castro L, Pilar C, Barreira C, Nogueira R, Gonçalves J. A Supra-Numerary Limb Grafted Onto a Sacrococcygeal Mass in a Child With Spinal Dysraphism: Case Report, Dysmorphogenesis, and Management Review. Birth Defects Res 2025; 117:e2447. [PMID: 39902726 DOI: 10.1002/bdr2.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 12/15/2024] [Accepted: 01/19/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Externally attached supra-numerary body structures are a rare congenital malformation. Dysmorphogenesis remains controversial, hence many different classifications have been proposed over the years. We report a case of a supra-numerary lower limb grafted onto a sacrococcygeal mass in a child with a myelomeningocele. Prevailing theories for its origin are revised as well as prenatal and postnatal management. CASE The case relates to a female neonate with a third lower limb grafted to a lumbosacral mass found upon birth. Postnatal imaging revealed a lipomyelomeningocele and a supra-numerary limb. Surgical intervention was performed on day seven of life with removal of the supra-numerary limb and correction of the dural defect. Anatomopathologic study revealed mature and dysplastic tissues of the three germlines. The infant was discharged after 16 days to follow-up by a multidisciplinary team. In early follow-up, minor asymmetry in lower limb mobility, peri-anal anesthesia, and bladder incontinence was present. Currently 8 years old, the patient has no motor or sensory dysfunction. CONCLUSIONS This case challenges the existing theories for conjoined twinning, as they do not fully explain the co-occurrence of neural tube defects in sacrally fused supra-numerary structures. Whether these malformations are entities of a single disease spectrum or the result of independent dysmorphogenesis is debated. Prenatal diagnosis with sequential investigation of morphogenesis as well as postnatal anatomopathological examination are crucial for a better understanding of complex biologic processes.
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Affiliation(s)
- Kaylene Freitas
- Serviço de Pediatria, Hospital Dr. Nélio Mendonça, Centro Hospitalar do Funchal, Funchal, Portugal
| | - Leonor Castro
- Serviço de Medicina Intensiva Neonatal e Pediátrica (SMINP), Hospital Dr. Nélio Mendonça, Centro Hospitalar do Funchal, Funchal, Portugal
| | - Carla Pilar
- Serviço de Cirurgia Pediátrica, Hospital Dr. Nélio Mendonça, Centro Hospitalar do Funchal, Funchal, Portugal
| | - Catarina Barreira
- Serviço de Neurocirurgia, Hospital Dr. Nélio Mendonça, Centro Hospitalar do Funchal, Funchal, Portugal
| | - Rosete Nogueira
- Medicine School and ICVS, ICVS/3B's PT Government Associate Laboratory, Minho University, Braga, Portugal
- LAP, UPPEF, CGC Genetics, Unilabs, Porto, Portugal
| | - Jenny Gonçalves
- Serviço de Medicina Intensiva Neonatal e Pediátrica (SMINP), Hospital Dr. Nélio Mendonça, Centro Hospitalar do Funchal, Funchal, Portugal
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Saaiq M, Zimri FK, Zaman KU. Successful Treatment of Well-Developed Accessory Lower Limb Associated with Spinal Dysraphism. World J Plast Surg 2020; 9:73-81. [PMID: 32190596 PMCID: PMC7068195 DOI: 10.29252/wjps.9.1.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 01/28/2023] Open
Abstract
Accessory lower limb with spinal dysraphism are amongst the rarest known anomalies. We successfully managed a 5-months old female infant with surgical ablation of the accessory lower limb and repair of the associated large lipomyelomeningocele. A comprehensive review of the relevant literature was undertaken and presented herein. A classification system for accessory lower limb is also proposed.
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Affiliation(s)
- Muhammad Saaiq
- Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Faridullah Khan Zimri
- Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Khaleeq-uz Zaman
- Department of Neurosurgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
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3
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Morath-Huss U, Drögemüller C, Stoffel M, Precht C, Zanolari P, Spadavecchia C. Polymelia in a chimeric Simmental calf: nociceptive withdrawal reflex, anaesthetic and analgesic management, anatomic and genetic analysis. BMC Vet Res 2019; 15:102. [PMID: 30922306 PMCID: PMC6440010 DOI: 10.1186/s12917-019-1846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Polymelia is a congenital defect characterized by one or more supernumerary legs. The genetics and aetiology of this condition in cattle have not yet been thoroughly investigated even though several case reports do exist. The model of the nociceptive withdrawal reflex (NWR) has been characterized in several species to study spinal nociceptive processing. It is a polysynaptic spinal reflex that can be elicited by noxious electrical stimulation and recorded by electromyography. Thorough nociceptive examination and preventive analgesic management has not yet been an aspect in the perioperative management of polymelia cases. CASE PRESENTATION A 4-month-old female Simmental calf was presented with notomelia. The animal was in good health and showed no neurologic deficiencies. Preoperatively, computed tomography was performed to gain more detailed anatomical information. To evaluate the sensitivity of the accessory limb, NWR testing was performed and revealed a connection of the afferent reflex pathway of the accessory limb to the efferent of the normal limb. The accessory limb was surgically removed under general anaesthesia. Intensive care included multimodal pain therapy adapted to the pain intensity scored during regular pain assessment. A gross anatomical dissection as well as a genetic analysis of the accessory limb were performed postoperatively. The calf was identified as a chimera. CONCLUSION This calf was successfully relieved of its accessory limb. Chimerism has not been described in the congenital defect polymelia. As the accessory limb was pain sensitive and a common nociceptive reflex pathway was identified, thorough perioperative pain management was performed with the intention to prevent chronic neuropathic pain development.
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Affiliation(s)
- Ute Morath-Huss
- Department of Veterinary Clinical Science, Anaesthesiology and Pain Therapy Division, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, 3012 Bern, Switzerland
| | - Cord Drögemüller
- Institute of Genetics, Vetsuisse Faculty, University of Bern, 3001 Bern, Switzerland
| | - Michael Stoffel
- Division of Veterinary Anatomy, Department of Clinical Research and VPH, Vetsuisse Faculty, University of Bern, POB 3350, 3001 Bern, Switzerland
| | - Christina Precht
- Clinical Radiology, Department of Clinical Veterinary Medicine, University of Bern, Länggassstrasse124, 3012 Bern, Switzerland
| | - Patrik Zanolari
- Clinic for Ruminants, Vetsuisse Faculty, University of Bern, Bremgartenstrasse 12, 109a, 3012 Bern, Switzerland
| | - Claudia Spadavecchia
- Department of Veterinary Clinical Science, Anaesthesiology and Pain Therapy Division, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, 3012 Bern, Switzerland
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Kelani AB, Moumouni H, Issa AW, Younsaa H, Fokou H, Sani R, Sanoussi S, Denholm LJ, Beever JE, Catala M. Notomelia and related neural tube defects in a baby born in Niger: case report and literature review. Childs Nerv Syst 2017; 33:529-534. [PMID: 28083641 DOI: 10.1007/s00381-017-3337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Notomelia associated with neural tube defects are rare diseases. CASE REPORT A baby was born in Niger with multiple congenital embryonic malformations on the posterior midline. The most rostral malformation was an accessory limb (polymelia) at the level of the lumbar vertebrae composed of two long bones, a foot and three toes. Accessory male genitalia were present at the base of this malformed accessory limb which had no apparent motor or sensory innervation. The second malformation was a sacral vestigial appendage with an adjacent dermal sinus opening onto the posterior midline and extending internally to the dura through a defect of the vertebral arches. From the published literature and this particular case, we conclude that notomelia is a rare clinical sequela of a neural tube defect (NTD) and is correctly classified as a dysraphic appendage. CONCLUSION The recent occurrence of three similar cases in the same ethnic group from Niger, three from consanguineous parents, suggests that genetic factors are likely to contribute significantly to the genesis of this syndrome, consistent with a recent report that mutation of the bovine NHLRC2 gene resulting in a V311A substitution at a highly conserved locus in the NHLRC2 protein is, when homozygous, causally associated with several forms of polymelia including notomelia, with heteropagus conjoined twinning and with other NTD-related embryonic malformations. Detailed genome-wide studies of children with dysraphic appendages are indicated.
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Affiliation(s)
- A B Kelani
- Département de Chirurgie, Faculté des Sciences de la Santé (FSS), Université Abdou Moumouni (UAM), Niamey, Niger
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - H Moumouni
- Département d'Embryologie, FSS, UAM, Niamey, Niger
| | - A W Issa
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - H Younsaa
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - Hmu Fokou
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - R Sani
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - S Sanoussi
- Département de Chirurgie, Faculté des Sciences de la Santé (FSS), Université Abdou Moumouni (UAM), Niamey, Niger
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - L J Denholm
- NSW Department of Industry, Orange NSW, Australia
| | - J E Beever
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M Catala
- Sorbonne Université, UPMC Université Paris 06, UMR7622, F-75005, Paris, France.
- CNRS, Institut de Biologie Paris Seine (IBPS) - Developmental Biology Laboratory, UMR7622, F-75005, Paris, France.
- INSERM, ERL1156, F-75005, Paris, France.
- Fédération de Neurologie, Groupe hospitalier Pitié-Salpêtrière-APHP, F-75013, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France.
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Proposed caudal appendage classification system; spinal cord tethering associated with sacrococcygeal eversion. Childs Nerv Syst 2017; 33:69-89. [PMID: 27497702 DOI: 10.1007/s00381-016-3208-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The most commonly used classification system for caudal appendages (aka human tails) dates from the 1980s and classifies appendages (tails) as either true tails or pseudotails. Advances in neuroimaging since the 1980s, however, as well as an ever-increasing number of reported cases, have made this system outdated. Sacrococcygeal eversion is a condition in which the distal sacral and coccygeal vertebrae are curved in a retroverted rather than anteverted direction. It can give rise to one type of caudal appendage. Sacrococcygeal eversion has never been associated with spinal cord tethering in any previously published reports. METHODS We reviewed all cases of caudal appendage encountered by pediatric neurosurgeons at Children's Hospital Colorado since 2000 in which the appendage would be classified as a true tail by the most commonly used system mentioned above. We also reviewed cases of sacrococcygeal eversion encountered since 2000 by the same group of pediatric neurosurgeons. We searched the hospital electronic medical record system for additional appendages using the terms "caudal appendage" and "persistent human tail." RESULTS We found 9 "true" tails (as classified by the most commonly used system). All 9 were associated with tethering or possible tethering of the spinal cord and 6 were associated with a low-lying conus medullaris. There were 8 cases of sacrococcygeal eversion, including 2 associated with Apert or Pfeiffer syndrome and fibroblast growth factor receptor 2 (FGFR2) mutations; these have previously been reported. There was a single case of sacrococcygeal eversion associated with Goldenhar or Turner syndrome; the former was associated with a potentially tethering lesion. Four cases of sacrococcygeal eversion not associated with any known syndrome were also found; two of these were associated with tethering or potentially tethering lesions. CONCLUSIONS Most so-called true tails are likely cutaneous markers for spinal dysraphism and spinal cord tethering and are not remnants of the embryonic human tail. Sacrococcygeal eversion can be associated with spinal cord tethering. Based on our cases, and on review of the literature, we devised a five-category classification system for caudal appendages: (1) soft-tissue caudal appendages, (2) bony caudal appendages, (3) bony caudal prominences, (4) true tails, and (5) "other" caudal appendages.
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Accogli A, Pavanello M, Accorsi P, De Marco P, Merello E, Pacetti M, Nozza P, Fiorillo C, Pinelli L, Cama A, Rossi A, Catala M, Capra V. Spinal lipoma as a dysembryogenetic anomaly: Four unusual cases of ectopic iliac rib within the spinal lipoma. ACTA ACUST UNITED AC 2016; 106:530-5. [DOI: 10.1002/bdra.23489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/29/2015] [Accepted: 01/06/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Patrizia Accorsi
- U.O. Neuropsichiatria dell'Infanzia e dell'Adolescenza, Spedali Civili; Brescia Italy
| | | | | | | | | | | | | | | | | | - Martin Catala
- Fédération de Neurologie; Groupe hospitalier Pitié-Salpêtrière APHP; Paris France
- Sorbonne Universités; UPMC Université Paris 06; UMR7622 Paris France
- CNRS; Institut de Biologie Paris Seine (IBPS) - Developmental Biology Laboratory; UMR7622 Paris France
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Abstract
A patient with lipomyelomeningocele (known in utero) presented for MRI characterization prior to surgical procedure at three months of age. Cross-sectional imaging revealed a spinal dysraphism of the lower lumbar spine, with a posterior spinal defect spanning L4 to S2 subcutaneous fat intrusion, and distal spinal cord extrusion. An osseous excrescence was also appreciated, articulating with the left iliac bone. This case demonstrates the youngest known lipomyelomeningocele with accessory limb and the abnormal growth of multiple tissue types at the site of spinal dysraphism-a potential consequence of dedifferentiated cell proliferation originating from a secondary neural tube defect or rachipagus parasitic twinning.
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Lipomatous Lumbar Mass with an Attached Digit and Associated Split Cord Malformation. Can J Neurol Sci 2014; 35:250-4. [DOI: 10.1017/s0317167100008738] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:A male infant was born with a digit attached to a skin-covered lumbar lipomatous mass and an underlying split cord malformation.Methods:Surgical removal of the mass was performed at four months-of-age. By this time the digit had grown a nail and imaging and histology showed ongoing development of articulated phalanges.Results:The lipomatous mass contained a long bone, a clavicle-and scapula-like structure and a variety of other mature germ layer derivatives. These features raised a number of diagnostic considerations, including: mature teratoma, hamartoma, rudimentary parasitic twin, lipomyelomeningocele and dorsal accessory limb.Conclusions:Based on review of the literature, the authors hypothesize that there is a pathogenetically related spectrum of skin-covered dorsal mass lesions, often associated with spinal dysraphism. These consist of a major lipomatous component and a variety of mature germ layer derivatives that can vary widely in their degree of anatomical organization from case to case.
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Bayri Y, Tanrıkulu B, Ekşi MS, Dağçınar A. Accessory lower limb associated with spina bifida: case report. Childs Nerv Syst 2014; 30:2123-6. [PMID: 25092402 DOI: 10.1007/s00381-014-2475-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Heterotopic redundancies, such as an accessory limb associated with spina bifida, are extremely rare anomalies. There are 12 cases of accessory limb associated with spinal bifida in literature. This report aims a detailed description of the additional case and an analysis of the findings in light. METHODS A male baby was born at 40 weeks of gestation and was referred to the neurosurgery clinic with a diagnosis of accessory lower limb. On physical examination, the dorsal meningocele was located at the lumbosacral region and there was accessory lower limb on it. There was no open neural placode. RESULTS The accessory limb was excised on postnatal day 3. CONCLUSIONS Dysraphic appendages are rare and complicated anomalies. They should be investigated carefully, and all of the lesions must be repaired for babies' quality of life.
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Affiliation(s)
- Yaşar Bayri
- Faculty of Medicine, Department of Neurosurgery, Marmara University, Marmara Üniversitesi Tıp Fakültesi, Selimiye M. Tıbbiye C. No:38, 34668, Haydarpaşa, Istanbul, Turkey,
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Parks C, Mugamba J. Accessory limb with myelomeningocele: a rare case challenging previously held beliefs. Childs Nerv Syst 2014; 30:2127-8. [PMID: 24881034 DOI: 10.1007/s00381-014-2452-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/23/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There have been previous reports of intra-scapular limbs associated with a closed spina bifida and this has led to a causative theory. It is thought that these dysraphic appendages could not occur with defects of primary neurulation. CASE The authors present a rare case of this abnormality associated with a large open myelomeningocele in a 6-day-old infant presenting to a paediatric neurosurgical hospital in Uganda. The appendage was removed and the spina bifida closed. There was significant stigma associated with such abnormality in this region. DISCUSSION The first reported co-existence of these two lesions challenges previously held beliefs regarding the embryological origin of intra-scapular dysraphic appendage.
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Abstract
At 7 months, an infant born with a third limb attached to a lumbosacral mass with an associated lipomyelomeningocele underwent removal of the limb and spinal cord detethering. Depending on the complexity of the pathology and proximity of the limb to viscera, consultation with neurosurgical and surgical colleagues is recommended.
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12
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Garg K, Kumar R. Complex spinal dysraphism with multiple anomalies. Pediatr Neurosurg 2013; 49:126-8. [PMID: 24526014 DOI: 10.1159/000358095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/18/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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13
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Lee SH, Je BK, Kim SB, Kim BH. Adult with sacral lipomyelomeningocele covered by an anomalous bone articulated with iliac bone: computed tomography and magnetic resonance images. Congenit Anom (Kyoto) 2012; 52:115-8. [PMID: 22639999 DOI: 10.1111/j.1741-4520.2011.00335.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present paper reports and discusses a case of sacral lipomyelomeningocele with an anomalous long bone articulating with the left iliac bone in a 40-year-old female. That patient had a monozygotic twin sister who had normal spine. The findings were incidental during an evaluation for a urinary tract infection. The computed tomography (CT) and magnetic resonance (MR) images revealed sacral dysraphism, lipomyelomeningocele, tethered spinal cord, and profound subcutaneous fat in the sacrococcygeal region. In addition, an anomalous bony strut was demonstrated on the posterior aspect of the sacrum, covering the sacral defect and the associated lipomyelomeningocele. The 3-D CT images of the anomalous bone associated with the sacral lipomyelomeningocele and the putative embryologic process are presented with a review of the literature.
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Affiliation(s)
- Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
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Heteropagus (parasitic) twins: a review. J Pediatr Surg 2010; 45:2454-63. [PMID: 21129567 DOI: 10.1016/j.jpedsurg.2010.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/21/2022]
Abstract
Heteropagus, or "parasitic," twins are asymmetric conjoined twins in which the tissues of a severely defective twin (parasite) are dependent on the cardiovascular system of the other, largely intact twin (autosite) for survival. The estimated incidence of heteropagus twins is approximately 1 per 1 million live births. Isolated case reports comprise most of published work on this rare congenital anomaly. In the past, review articles have focused narrowly on one particular anatomical subtype of parasitic twin and/or on the anatomicopathology observed. Here, we present the epidemiology, proposed pathoembryogenic origins, anatomical abnormalities, management, and outcomes of the wide array of heteropagus twins described in the English language literature.
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Wasnik AP, Shinagare A, Lalchandani UR, Gujrathi R, Pai BU. Rudimentary third lower limb in association with spinal dysraphism: Two cases. Indian J Orthop 2007; 41:72-5. [PMID: 21124687 PMCID: PMC2981900 DOI: 10.4103/0019-5413.30530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spinal dysraphism is a common congenital anomaly with many associated variants. One of the rarest associated findings is a full grown or rudimentary third limb, collectively called Tripagus. We present two cases of spinal dysraphism with rudimentary third limb arising from the ilium.
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Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, Grant Medical College and Sir J.J Group of Hospital, Byculla, Mumbai - 400 008, India,Correspondence: Dr. Ashish P. Wasnik, C/o Mr. R. Lalchandani, 2, Neel Kamal Apts, O.T Section, Ulhasnagar - 421 001, India. E-mail:
| | - Atul Shinagare
- Department of Radiology, Grant Medical College and Sir J.J Group of Hospital, Byculla, Mumbai - 400 008, India
| | - Usha R Lalchandani
- Department of Radiology, Grant Medical College and Sir J.J Group of Hospital, Byculla, Mumbai - 400 008, India
| | - Rahul Gujrathi
- Department of Radiology, Grant Medical College and Sir J.J Group of Hospital, Byculla, Mumbai - 400 008, India
| | - Bhujang U Pai
- Department of Radiology, Grant Medical College and Sir J.J Group of Hospital, Byculla, Mumbai - 400 008, India
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Abstract
A rare case of a newborn girl presenting with a mass representing an aborted parasitic twin attached to the back in the midline over the lumbosacral region (parasitic rachipagus) is reported. Rudimentary digits were attached to the mass, and in one area, the overlying skin resembled scrotal skin. A depression resembling an anal dimple was also present on the surface of the mass. Investigations showed a well-developed long bone and other small bones within the parasite, and sacral spina bifida in the autosite. Successful surgical excision of the parasitic mass was performed. A review of the literature pertaining to parasitic rachipagus twinning is presented.
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Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and associated Kalawati Saran and SK Hospitals, New Delhi 110001, India.
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