Accessory limb attached to the back

Successful Treatment of Well-Developed Accessory Lower Limb Associated with Spinal Dysraphism

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.

Notomelia and related neural tube defects in a baby born in Niger: case report and literature review

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.

Parasitic rachipagus twins; report of two cases

BACKGROUND

Parasitic fetus is a kind of conjoined twin, in which one of the twins is resorbed and some parts of the body can remain attached to the other twin. In the spinal form of parasitic twin--the so-called parasitic rachipagus--an ectopic or accessory limb is attached to the back of a normal baby or only a mass of viable tissue may remain.

METHOD

Here, we report two cases of rachipagus that one had a lower extremity on her back and the other had some tissues similar to genitalia and formed bony structures on his back.

An accessory limb with an imperforate anus

Congenital accessory limbs are very rare anomalies with many causative factors. We describe the case of a 1-day-old female neonate-born to a healthy, 27-year-old mother-who presented with an accessory limb (foot) attached to the buttock and an imperforate anus. We also provide a review of the relevant literature.

An accessory limb with lipomyelomeningocele in a male

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.

A rare form of heteropagus twinning: three-armed infant with spinal dysraphism

An ectopic or accessory limb attached to the back is an extremely rare and strange condition, and there are only a few documented cases in the worldwide literature. The first case was described by Jones and Larkin (1889). There are several theories regarding the origin of this condition. Asymmetric conjoined twinning which is located dorsally in the vertebral column (rachipagus) is the most probable diagnosis of our patient. Conjoined twinning is very rare and the incidence is 1 per 50 000 live births. Rachipagus is even rarer, with no more than 30 case reports so far (Chadha et al. (1993, 2006)). In this report, we present a patient who underwent successful surgical excision of a third arm attached to the back in the midline over the low-dorsal region. Differential diagnoses including teratoma and fetus in fetu are discussed.

Rachipagus: a report of two cases - thoracic and lumbar

We present two cases of rachipagus in two male infants and review the literature on this anomaly. These infants were from consanguineous marriages and cases of twins were reported in their families. In the first case it was a limb attached to the lower lumbar region with a rudimentary posterior arch. At the junction there was a lipomeningocele. Anatomical dissection of the limb identified the bones of the lower limb. In the second case, the parasites were joints of the upper limb that were attached to the chest by rudimentary posterior arches. In both cases there was only one spinal canal and a single spinal cord. Except the spina bifida in the first case no other malformation was diagnosed. The parasites were successfully excised. The two patients are well at one year of follow-up. Rachipagus is a rare embryogenic malformation with a good prognosis in the absence of associated congenital anomalies.

Rudimentary third lower limb in association with spinal dysraphism: Two cases

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.

Lumbosacral parasitic rachipagus twin

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.

Thoracolumbar accessory penis: etiology, diagnosis, and management

Human sacral appendages have rarely been reported. We present a neonate with a thoracolumbar appendage resembling a penis, and discuss the nature of the anomaly and its diagnosis and management.

Rachipagus conjoined twins: they really do occur!

The myth of rachipagus twins is hereby exploded-the myth, not the rachipagus! In a review of over 1,200 cases of conjoined twins, one classic example of rachipagus was found-two complete infants with dorsal union of the entire head and trunk, with roentgenograms showing clearly visible bony union of the vertebral arches from T6 to L3. After the typical case was discovered, 20 dorsal parasitic twins were reevaluated and reclassified as rachipagus. Two had extensive vertebral fusion and 18 were united in the dorsal midline, all with a meningocele, vertebral anomaly, and/or bony or neural connection. A theory of the embryologic origin of these twins is proposed: two embryonic discs located on diametrically opposing aspects of a single amniotic cavity becoming united in the area of the closing neural folds. This again raises the controversy concerning "fission or fusion" in conjoined twins.