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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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Anatomical features and challenges in separation and reconstruction of heteropagus twins. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Alves RDCS, Petry AUS, Marçal JMB, Hochhegger B, Damin AS, Roehe AV. Asymmetric parasitic twins - Heteropagus. ACTA ACUST UNITED AC 2020; 66:1526-1529. [PMID: 33295404 DOI: 10.1590/1806-9282.66.11.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asymmetric or heteropagus conjoined twins is a rare occurrence, with an incidence of one case in 1-2 million. Conjoined twins are classified according to their symmetry, place of fusion, and grade of duplication. METHODS We report here an extremely rare presentation of parasitic twins not described before. We describe macro and micro anatomic alterations and discuss the aspects of this peculiar presentation and the importance of prenatal diagnosis. RESULTS The case of a twenty-three-year-old patient, with monochorionic, monoamniotic asymmetrically-conjoined twin pregnancy, discovered at 29 weeks of gestational age. We believe that this report calls attention to this presentation and the importance of prenatal care and management. The twins were delivered vaginally without life. The twins' combined weight was 1.300 gr. They were bonded in the left cervical region. CONCLUSION This report may help to find strategies for clinical decisions in future cases. Antepartum diagnosis is important to the management, preoperative planning, and outcomes. Prenatal imaging exams like echocardiography, CT, MRI, and ultrasonography are feasible and can provide relevant information about malformation severity and prognosis.
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Affiliation(s)
- Rita de Cássia S Alves
- Docente, Departamento de Métodos Diagnósticos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Adriana Ubirajara Silva Petry
- Docente, Departamento de Métodos Diagnósticos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Josenel Maria Barcelos Marçal
- Docente, Departamento de Métodos Diagnósticos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Bruno Hochhegger
- Docente, Departamento de Métodos Diagnósticos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Andréa Souto Damin
- Docente, Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Adriana Vial Roehe
- Docente, Departamento de Métodos Diagnósticos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
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Asymmetric Omphalopagus in a Triplet after In Vitro Fertilization: A Rare Case of Conjoined Twinning. Case Rep Pediatr 2018; 2018:9349606. [PMID: 30210891 PMCID: PMC6126085 DOI: 10.1155/2018/9349606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Asymmetric omphalopagus is a rare situation of conjoined twinning, in which a grossly defective twin is attached to the thorax and upper abdomen of the main twin. We describe a case of an asymmetric omphalopagus accompanied by a normal triplet after assisted reproductive technology (ART) and tried to further characterize the all aspects of the conjoined twins. Case Presentation: Perioperative diagnostic imaging was carried out followed by an autopsy to evaluate all aspects of the parasite accompanied by histological, immunohistochemical, and molecular biological evaluation. The parasite had well-developed lower extremities as well as upper extremities with a cleft hand syndrome. The sex was nondeterminable, but DNA fingerprinting revealed that both parasite and autosite are monozygotic, so are females. There was no sign of any axial skeleton or central nervous system. We found a rudimentary rectum with a nonpervious anus, a kidney, ureter, urinary bladder, and a blind-ending urethra. The blood supply of the parasite was connected to the vessel system of the autosite. Conclusions To our knowledge, only two cases of parasitic omphalopagus after ART have been described to date. Altogether, 52 cases have been reported, and in most of them, the parasites were successfully separated.
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Yoshioka K, Ishikawa A, Sugiyama M, Nagasao J, Kikuchi M. A case of a giant mass in the lumbar region of a newborn calf. Okajimas Folia Anat Jpn 2017; 94:1-6. [PMID: 29213014 DOI: 10.2535/ofaj.94.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present report describes a newborn calf with spina bifida that presented with a giant mass of the lumbar region, as well as subsequent gross, histological, and immunohistochemical examinations. A malformed Japanese black calf (estimated weight = 20 kg) was euthanized immediately after birth. A gross evaluation revealed a giant mass (approximately 60 cm × 30 cm × 15 cm) covered by the hair coat in the lumbar region and connected with the hair coat of the trunk. The mass surface was divided by a deep polygonal groove and externally resembled a lobulated kidney. Histology and immunohistochemistry revealed that the giant mass comprised a vessel, bronchiolus lined with cuboidal epithelium, and small alveolus. Bone bleaching revealed various abnormalities, including spina bifida, vertebral fusion, vertebral deformity, vertebral malformation, vertebral scoliosis, and coxal bone malformation. Following a suggestion that the giant lumbar region mass was occupied by lung tissue, this case was considered to involve an asymmetric conjoined duplicitas that resulted in a very rare dichotomous spondylosis malformation.
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Affiliation(s)
- Kazuki Yoshioka
- Laboratory of Veterinary Anatomy, School of Veterinary Medicine, Kitasato University
| | - Aika Ishikawa
- Laboratory of Veterinary Anatomy, School of Veterinary Medicine, Kitasato University
| | - Makoto Sugiyama
- Laboratory of Veterinary Anatomy, School of Veterinary Medicine, Kitasato University
| | | | - Motohiro Kikuchi
- Laboratory of Theriogenology, School of Veterinary Medicine, Kitasato University
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LDT classification and therapeutic strategy of congenital body wall defects. J Plast Reconstr Aesthet Surg 2017; 71:384-393. [PMID: 29029959 DOI: 10.1016/j.bjps.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/09/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Repairing body wall defects is a critical step in the treatment of some congenital deformities, and this procedure may need the help from plastic surgeons. Although there are many articles about congenital deformities, body wall defects of these malformations are rarely studied as independent targets. METHODS In this article, the authors present an LDT classification for congenital body wall defects according to the position of the defects, the tissue layers involved, and the surgical urgency, each of which is represented by letters L, D, and T, respectively. That is, the defects in different areas (L), full-thickness (D1), or partial (D0A, D0B) defects, defects needing instant repair (T2), semi-elective repair (T1), or elective repair (T0). Based on this classification system, the authors have performed body wall reconstruction on two pairs of thoraco-omphalopagus twins, one pair of ischiopagus tetrapus twins, and an infant and an adult, both of whom were diagnosed with pentalogy of Cantrell associated with ectopia cordis. RESULTS Except for one pair of thoraco-omphalopagus twins who died after emergency separation, all the other patients survived. Another pair of thoraco-omphalopagus twins suffered from wound dehiscence and partial flap necrosis, respectively, after surgery. An expanded polytetrafluoroethylene mesh in one sister of the ischiopagus twins was removed because of infection. CONCLUSIONS LDT classification not only can help doctors categorise different congenital body wall defects rapidly and easily, but can also guide the reconstruction of these defects. It may have clinical value to plastic surgeons to some extent.
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Recurrence of parasite in epigastric heteropagus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ahmed K, Mahdi BD, Hayet Z, Hamdi L, Mohamed J, Riadh M. Thoracic heteropagus conjoined twins associated to an omphalocele: Report of a case and complete review of the literature. Afr J Paediatr Surg 2016; 13:209-212. [PMID: 28051055 PMCID: PMC5154231 DOI: 10.4103/0189-6725.194670] [Citation(s) in RCA: 2] [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: 11/29/2022] Open
Abstract
Heteropagus twins are an extremely rare event with an incidence of 1-2 million live births that represents, sometimes, a real challenge for paediatric surgeons. The majority of cases have complete or partial duplication of the pelvis and/or lower extremities. Thoracic heteropagus conjoined twins is a rare condition in which a grossly defective foetus (the parasite) is attached to the thorax of the main foetus (the autosite). We describe a case of a parasitic heteropagus attached at the chest wall with a rare presentation of giant exomphalos on the autosite. In this situation, the separation procedure was simple after a well-done anatomic study using X-ray, ultrasonography, magnetic resonance and echocardiogram are performed.
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Affiliation(s)
- Kotti Ahmed
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
| | - Ben Dhaou Mahdi
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
| | - Zitouni Hayet
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
| | - Louati Hamdi
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
| | - Jallouli Mohamed
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
| | - Mhiri Riadh
- Department of Pediatric Surgery, Hedi Chaker Hospital, 30219 Sfax, Tunisia
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