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Parasitic limb excision in a neonate: a rare occurrence. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Parasitic limb is a rare congenital anomaly. Its incidence is less than 1 in 1 million live births. It refers to the type of conjoined twin in which tissues of an incompletely formed twin (parasite) are attached to and dependent upon a fully developed twin. Since it is a rare anomaly, all the cases should be reported.
Case presentation
This study reports a 3-day-old neonate admitted to the Children's Hospital Emergency. Her initial complaints were an extra limb arising from her lower back. She was born as a result of cousin marriage and was not diagnosed antenatally. The limb was attached to the lower lumbar region (L4, L5, S1). The limb was hypoplastic, and the baby was unable to hold it against the gravity but she cried when it was pinched suggesting pain sensations. Preoperative diagnostic workup was done, and parasitic limb was excised.
Conclusion
Every child with parasitic limb is a surgical dilemma. Thus, a multi-disciplinary approach and a carefully planned surgery with meticulous dissection can result in complete excision of a parasitic limb without any complications.
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Mathur P, Sharma S, Mittal P, Yadav RK, Barolia D. Heteropagus twins: six cases with systematic review and embryological insights. Pediatr Surg Int 2022; 38:963-983. [PMID: 35567628 DOI: 10.1007/s00383-022-05135-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described. METHODS Six cases of HT managed at two tertiary care teaching hospitals over the last 26 years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed. RESULTS Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases. CONCLUSION Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Praveen Mathur
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Mittal
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India.
| | - Raj Kumar Yadav
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Dinesh Barolia
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India
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Zhi X, Hu B, Zhao X, Chen J, Gu C, Pu L, Fang Y, Cai C. A cohort of five cases with asymmetric conjoined twining and literature review. Pediatr Surg Int 2022; 38:169-181. [PMID: 34467432 DOI: 10.1007/s00383-021-05006-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE Asymmetric conjoined twining (ACT) is a form of conjoined twining which is a rare malformation of monochorionic monoamniotic twin pregnancy. Most publications were single case reports. We reported a cohort of five cases with ACT from a single tertiary medical center and reviewed the case reports of ACT over the last decade to enrich the clinical research of this disease and summarized the clinical features of the disease. METHODS We reviewed five cases of ACT admitted in Tianjin Children's Hospital from 17 March, 2008, through 7 March 2017. The cohort was analysed from general information, imaging manifestations, separation surgery, histopathological findings, outcome and follow-up. We searched the English literatures on case reports of ACT over the past decade from the PubMed database and presented details about the clinical characteristics, treatment, and prognosis of all cases. RESULTS There were four males and one female in our cohort. Among the five cases, two parasites were located in epigastrium, two in rachis, and one in retroperitoneum (fetus in fetu, FIF). All of the parasites were separated successfully by operation in five cases and were confirmed to be ACT by histopathology reports. Four patients made an uneventful recovery except for one case of wound infection. All of them were doing well in follow-up. In the literature review, we found 41 cases of exoparasitic heteropagus twining (EHT) and 63 cases of FIF. CONCLUSIONS ACT is very rare and usually diagnosed by prenatal ultrasonography (US). Computed tomography (CT) and magnetic resonance imaging (MRI) examinations are essential imaging examinations before separation surgery to delineate the anatomical relationship between the autosite and the parasite. In general, the separation surgery of ACT is less complicated and the prognosis is better compared with the symmetric conjoined twining (SCT).
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Affiliation(s)
- Xiufang Zhi
- Graduate College of Tianjin Medical University, Tianjin, 300070, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China
| | - Bo Hu
- Department of Neonatal Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Xuwen Zhao
- Department of Neonatal Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Jing Chen
- Department of Radiology, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Chunyu Gu
- Graduate College of Tianjin Medical University, Tianjin, 300070, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China
| | - Linjie Pu
- Graduate College of Tianjin Medical University, Tianjin, 300070, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China
| | - Yulian Fang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China.,Tianjin Pediatric Research Institute, Tianjin, 300134, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
| | - Chunquan Cai
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China. .,Tianjin Pediatric Research Institute, Tianjin, 300134, China. .,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China. .,Department of Neurosurgery, Tianjin Children's Hospital, No. 238 Longyan Road, Beichen District, Tianjin, 300134, China.
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Zewdie K, Negash S, Bizuneh Y, Woldemichael F, Temesgen F. Rachipagus parasitic twins: A case series and review of literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Prenatal and postnatal MRI imaging findings of intracranial parasitic fetus: a case report. Childs Nerv Syst 2021; 37:1803-1806. [PMID: 32968878 DOI: 10.1007/s00381-020-04891-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022]
Abstract
Fetus in fetu (FIF) is an extremely rare anomaly. It is predominantly seen retroperitoneally in 80% of cases but can present at atypical sites like the skull, sacrum, scrotum and the mouth. We reported a rare case of intracranial parasitic fetus. We described the prenatal and postnatal MRI findings of the case. There was no obvious spinal signal on the imaging findings at 35 weeks of gestation. However, the postnatal MRI revealed spinal column signal at 5 months and 11 days.
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Bishop L, Jones B, Kelley D, Martin C. External parasitic twins. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Khavanin N, Ruge JR, Vicari FA, Belin EJ, Kellogg RG, Steinberg JP. Parasitic rachipagus conjoined twin: case report. J Neurosurg Pediatr 2018; 22:313-316. [PMID: 29882735 DOI: 10.3171/2018.3.peds1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A parasitic twin represents a rare developmental anomaly in which an asymmetrical, nonviable conjoined twin is attached to the host body at the time of birth. Rachipagus is among the rarest of conjoined twin subtypes and typically features a parasitic twin mass attached at the spine. Herein, the authors review the literature and describe the case of a 9-month-old girl presenting with a rachipagus parasitic twin consisting of a fully developed set of lower extremities originating from the midline upper back. After a complete workup to delineate parasite and autosite anatomy, the parasitic twin mass was successfully excised by a multidisciplinary team of surgeons, and the resulting defect was closed in a single stage.
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Affiliation(s)
- Nima Khavanin
- 1Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | | | | | - Eric J Belin
- 4Pediatric Orthopedic Surgery, Advocate Children's Hospital, Park Ridge, Illinois
| | | | - Jordan P Steinberg
- 1Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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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: 0.6] [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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Lund-Johansen M, Laeke T, Tirsit A, Munie T, Abebe M, Sahlu A, Biluts H, Wester K. An Ethiopian Training Program in Neurosurgery with Norwegian Support. World Neurosurg 2016; 99:403-408. [PMID: 28017754 DOI: 10.1016/j.wneu.2016.12.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/26/2022]
Abstract
After a 4-year planning period, a joint Ethiopian/Norwegian training program in neurosurgery was started in June 2006. The collaborating partners were Addis Ababa University; Department of Surgery, Tikur Anbessa Specialized Hospital; University of Bergen; Haukeland University Hospital; and Myungsung Christian Medical Center, a Korean missionary hospital in Addis Ababa, Ethiopia. A memorandum of understanding was signed at dean/chief executive officer levels. Although other initiatives have been involved in supporting neurosurgery in Addis Ababa during the same period, this institutionally founded program has been the main external contributor to neurosurgical capacity building through the education of 21 Ethiopian neurosurgeons, and in supporting a sustainable environment for neurosurgical training within a network of 5 centers in Addis Ababa. This article gives an account of the strategies underlying the program planning, the history of the program, and on the experience gained by it. Finally, ethical problems and challenges encountered in the program are discussed.
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Affiliation(s)
- Morten Lund-Johansen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
| | - Tsegazeab Laeke
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Abenezer Tirsit
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Tadios Munie
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Mersha Abebe
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Abat Sahlu
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Hagos Biluts
- Addis Ababa University, Department of Surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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