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Mohammad SA, AbouZeid AA, Ahmed KA, Abd-Elhamed AM, Rawash Eldieb LM. Postnatal imaging of conjoined twins: a customized multimodality approach. Pediatr Radiol 2023; 53:2291-2304. [PMID: 37466734 PMCID: PMC10562291 DOI: 10.1007/s00247-023-05709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/20/2023]
Abstract
Medical imaging plays a crucial role in the management of conjoined twins. The role of imaging is to explore the anatomy, outline the shared organs and determine whether surgery is feasible. It also serves as a roadmap for successful separation. Additionally, imaging helps with counseling parents about prognosis. This review aims to illustrate recent advances in different imaging modalities and their role in the management of the various types of conjoined twins with an emphasis on relevant tips for optimal imaging.
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Affiliation(s)
- Shaimaa Abdelsattar Mohammad
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Khaled A Ahmed
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abeer Maghawry Abd-Elhamed
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Leila M Rawash Eldieb
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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2
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Runggaldier D, Reinehr M, Friedrich H, Henze G, Good D, Gysin C. Case report and review of the literature: rare fetus-in-fetu presenting as oropharyngeal epignathus. Front Surg 2023; 10:1122327. [PMID: 37206355 PMCID: PMC10191252 DOI: 10.3389/fsurg.2023.1122327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
An epignathus is caused by a continuous spectrum of masses of the oral cavity or oropharynx ranging in its entity from mature teratoma to the exceedingly rare fetus-in-fetu. Due to its location, regardless of the entity, the occurrence of an epignathus is frequently associated with life threatening airway obstruction. Here we demonstrate a case of a fetus-in-fetu presenting as an epignatus. We describe its successful management and review the available literature. Early diagnosis and knowledge of the preoperative workup are essential to enable a multidisciplinary management. Once the airway is secured, surgical excision is the treatment of choice often resulting in a good clinical outcome and prognosis.
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Affiliation(s)
- Daniel Runggaldier
- Division of Pediatric Otolaryngology, University Children's Hospital, Zurich, Switzerland
- Departmentof Otorhinolaryngology, Head & Neck Surgery, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - Michael Reinehr
- Departmentof Otorhinolaryngology, Head & Neck Surgery, University Hospital Zürich, University of Zurich, Zürich, Switzerland
- Institute for Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Hergen Friedrich
- Division of Pediatric Otolaryngology, University Children's Hospital, Zurich, Switzerland
| | - Georg Henze
- Department of Anesthesia, University Children’s Hospital, Zürich, Switzerland
| | - Dominic Good
- Division of Pediatric Otolaryngology, University Children's Hospital, Zurich, Switzerland
| | - Claudine Gysin
- Division of Pediatric Otolaryngology, University Children's Hospital, Zurich, Switzerland
- Correspondence: Claudine Gysin
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3
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Conjoined Twins in Guinea Pigs: A Case Report. Animals (Basel) 2022; 12:ani12151904. [PMID: 35892553 PMCID: PMC9367370 DOI: 10.3390/ani12151904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cases of newborn connected twins, so-called Siamese twins, are well known in humans, laboratory mammals, domestic and wild birds, reptiles, amphibians and fish. This report describes a unique case of newborn conjoined twins in guinea pigs (Cavia aperea f. porcellus). Connected twins in guinea pigs have been very rare, and there are only a few previous reported cases. This report is only the fourth described case of the birth of conjoined guinea pigs. They were born in breeding in the Czech Republic in 2020. The conjoined twins were males connected in the upper body by a cephalopagus-type connection, which has occurred in all three previous reports. The skeletons of both the bodies were connected by a broad shared skull and sternum. Both of the fused bodies had their own hearts and livers, but the lungs were mutual. The issue of this anomaly has not yet been clearly explained. Abstract The report describes a unique case of newborn conjoined twins in guinea pigs (Cavia aperea f. porcellus). Connected twins in guinea pigs have been very rare, and there are only a few previous reported cases. The newborns were stillborn in breeding in the Czech Republic in 2020 as two bodies conjoined into one. The external and internal structure of the body and the type of connection of both of the bodies are described. The weights of selected internal organs of the twins are compared with those of normally developed newborn guinea pigs.
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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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Oostra RJ, Schepens-Franke AN, Magno G, Zanatta A, Boer LL. Conjoined twins and conjoined triplets: At the heart of the matter. Birth Defects Res 2022; 114:596-610. [PMID: 35766259 PMCID: PMC9546242 DOI: 10.1002/bdr2.2066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Conjoined triplets are among the rarest of human malformations, as are asymmetric or parasitic conjoined twins. Based on a very modest corpus of recent literature, we applied the embryonic disk model of conjoined twinning to 10 previously reported cases involving asymmetric anatomical multiplications to determine whether they concerned conjoined twins or conjoined triplets. In spite of their phenotypic similarities, we diagnosed four of these cases as conjoined twins and three of them as conjoined triplets. In the remaining three cases, no definite diagnosis could be made, as essential information was lacking from the reports. We conclude that it is not necessarily the expected duplication or triplication of structures that points to the correct diagnosis in these cases, but the number and mutual position of the hearts they presented with. Considering their rarity we stress to thoroughly investigate and describe internal (dys)morphology in novel cases of (asymmetric) conjoined twins and triplets to further unravel their pathogenicity and come to the correct diagnoses.
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Affiliation(s)
- Roelof-Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, The Netherlands
| | - Annelieke N Schepens-Franke
- Department of Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giovanni Magno
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Medical Humanities, Padua University Medical School and Museum of Pathological Anatomy, University Museums Centre, University of Padua, Padua, Italy
| | - Alberto Zanatta
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Medical Humanities, Padua University Medical School and Museum of Pathological Anatomy, University Museums Centre, University of Padua, Padua, Italy
| | - Lucas L Boer
- Department of Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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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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8
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Abiramalatha T, Balasubramanian R, Suman FR, Agarwal P, Balakrishnan U, Amboiram P. Diagnostic Dilemma of an Umbilical Mass in a Newborn Infant - a Twin or a Tumor? Fetal Pediatr Pathol 2021; 40:354-358. [PMID: 31875762 DOI: 10.1080/15513815.2019.1707920] [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] [Indexed: 10/25/2022]
Abstract
We present the diagnostic dilemma of a neonate with two umbilical soft tissue masses. Case report: The baby had an umbilical mass herniating through the umbilical cord, and another mass hanging from the umbilical mass by a string of tissue. Both masses were amorphous solid soft tissues and the hanging mass had hair on the surface. Clinical diagnosis was umbilical cord teratoma. However, histopathological examination of the masses showed that tissues representing various organs were arranged in cephalocaudal order as in a fetus, revealing that it was a parasitic twin. The hanging mass was probably the cephalic part and the umbilical mass was malformed torso and limbs. Conclusion: This parasitic omphalopagus heteropagus parasitic twin presented as two amorphous masses without externally identifiable anatomic structure, The parasitic twin of omphalopagus heteropagus may have unusual presentations. Histopathological examination was essential to diagnose whether it is a twin or a tumor.
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Affiliation(s)
| | | | - Febe Renjitha Suman
- Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Prakash Agarwal
- Pediatric Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | - Prakash Amboiram
- Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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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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10
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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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11
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One heart is not enough – conjoined twins: prenatal diagnosis and assessment of associated malformations. Case report. GINECOLOGIA.RO 2021. [DOI: 10.26416/gine.31.1.2021.4325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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12
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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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13
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Saravanan N, David LS, Vijayaselvi R, Masih D, Beck MM. What is your diagnosis? J Turk Ger Gynecol Assoc 2019; 20:269-271. [PMID: 31245967 PMCID: PMC6883750 DOI: 10.4274/jtgga.galenos.2019.2019.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nanthini Saravanan
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, South India
| | - Liji Sarah David
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, South India
| | - Reeta Vijayaselvi
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, South India
| | - Dipti Masih
- Department of Pathology, Christian Medical College and Hospital, Vellore, South India
| | - Manisha Madhai Beck
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, South India
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Pang H, Zang J, Qiu L. Prenatal diagnosis of parasitic conjoined twins using three-dimensional ultrasound: A case report. Int J Gynaecol Obstet 2019; 148:265-266. [PMID: 31651990 DOI: 10.1002/ijgo.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/16/2019] [Accepted: 10/24/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Houqing Pang
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Zang
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Qiu
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
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Teixeira Castro P, Werner H, Matos AP, Daltro P, Araujo Júnior E. Symmetric and ventrally conjoined twins: prenatal evaluation by ultrasound and magnetic resonance imaging and postnatal outcomes. J Matern Fetal Neonatal Med 2019; 34:1955-1962. [PMID: 31387430 DOI: 10.1080/14767058.2019.1651282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the perinatal and long-term outcomes of symmetric and ventrally conjoined twins evaluated prenatally by ultrasound and fetal magnetic resonance imaging (MRI). METHODS From March 2010 to January 2019, cases of symmetric and ventrally conjoined twins, who were prenatally diagnosed and referred to the Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil, for prenatal evaluation by ultrasound and MRI were selected. The postnatal information was collected from hospitals where the twins were born and/or treated and from parents' verbal and written information. RESULTS Four cases of symmetrical and ventrally conjoined twins were selected. Of these, two were omphalopagi and two thoracopagi. One pair of thoracomphalopagus died early in utero and the other died 6 days after birth. The outcome of the two omphalopagus pairs were separation in emergency surgeries after birth, with neonatal demise of one of the twins due to congenital malformations. In cases of omphalopagi, fetal MRI presented important information of the twins' anatomy before emergency separation of both pairs. CONCLUSION Despite the apparently similar conditions of twins with ventral fusion, ventrally attached twins have very different outcomes, most adverse for thoracomphalopagus and related to the singular anatomy of the pair, associated malformations and the extension of the adhesion, requiring individual evaluation of the cases. Fetal MRI is as an important tool for the postnatal surgery management of twin neonates, providing crucial information in cases where urgent separation is required.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Radiology, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Heron Werner
- Department of Radiology, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Ana Paula Matos
- Department of Radiology, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Pedro Daltro
- Department of Radiology, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Boer LL, Schepens-Franke AN, Oostra RJ. Two is a Crowd: Two is a Crowd: On the Enigmatic Etiopathogenesis of Conjoined Twinning. Clin Anat 2019; 32:722-741. [PMID: 31001856 PMCID: PMC6849862 DOI: 10.1002/ca.23387] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 12/31/2022]
Abstract
In this article, we provide a comprehensive overview of multiple facets in the puzzling genesis of symmetrical conjoined twins. The etiopathogenesis of conjoined twins remains matter for ongoing debate and is currently cited-in virtually every paper on conjoined twins-as partial fission or secondary fusion. Both theories could potentially be extrapolated from embryological adjustments exclusively seen in conjoined twins. Adoption of these, seemingly factual, theoretical proposals has (unconsciously) resulted in crystallized patterns of verbal and graphic representations concerning the enigmatic genesis of conjoined twins. Critical evaluation on their plausibility and solidity remains however largely absent. As it appears, both the fission and fusion theories cannot be applied to the full range of conjunction possibilities and thus remain matter for persistent inconclusiveness. We propose that initial duplication of axially located morphogenetic potent primordia could be the initiating factor in the genesis of ventrally, laterally, and caudally conjoined twins. The mutual position of two primordia results in neo-axial orientation and/or interaction aplasia. Both these embryological adjustments result in conjunction patterns that may seemingly appear as being caused by fission or fusion. However, as we will substantiate, neither fission nor fusion are the cause of most conjoined twinning types; rather what is interpreted as fission or fusion is actually the result of the twinning process itself. Furthermore, we will discuss the currently held views on the origin of conjoined twins and its commonly assumed etiological correlation with monozygotic twinning. Finally, considerations are presented which indicate that the dorsal conjunction group is etiologically and pathogenetically different from other symmetric conjoined twins. This leads us to propose that dorsally united twins could actually be caused by secondary fusion of two initially separate monozygotic twins. An additional reason for the ongoing etiopathogenetic debate on the genesis of conjoined twins is because different types of conjoined twins are classically placed in one overarching receptacle, which has hindered the quest for answers. Clin. Anat. 32:722-741, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucas L Boer
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelieke N Schepens-Franke
- Department of Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelof Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abdel-Latif M, Shalaby MS, Elhay SA. Conjoined Twins. CLINICAL EMBRYOLOGY 2019:475-480. [DOI: 10.1007/978-3-319-26158-4_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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18
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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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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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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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Bansal R, Paliwal N, Karnawat R, Kothari A. Anesthetic management of parasitic conjoined twins' separation surgery. Saudi J Anaesth 2018; 12:485-487. [PMID: 30100855 PMCID: PMC6044149 DOI: 10.4103/sja.sja_23_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Parasitic twin is a rare form of conjoined twins with an incidence ranging from 1 in 50,000 to 1,00,000 live births. In thoracopagus type, both hearts are joined together and often are associated with underlying congenital cardiac malformations. The separation surgery is a challenging task for both the surgeon as well as anesthetist due to the complexity of the procedure and long duration of surgery, carrying mortality close to 100% in case of significant cardiac fusion. Here, we are sharing anesthetic management of successful separation of a rare type of parasitic male conjoined twins who had connected hearts and common liver.
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Affiliation(s)
- Rakhi Bansal
- Department of Anesthesia, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Naveen Paliwal
- Department of Anesthesia, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Rakesh Karnawat
- Department of Anesthesia, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Akanksha Kothari
- Department of Anesthesia, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
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Grimes JA, Hespel AM, Cole RC, Dillon AR. A Case of Parasitic Twinning or Caudal Duplication in a Dog. J Am Anim Hosp Assoc 2018; 54:219-225. [PMID: 29757668 DOI: 10.5326/jaaha-ms-6559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6 mo old 13.5 kg (29.7 lb) male intact American Staffordshire terrier was evaluated for a history of supernumerary pelvic limbs, with malodorous discharge from a supernumerary penis. Imaging (radiographs, abdominal ultrasound, and computed tomography with excretory urogram) showed a supernumerary pelvis with associated pelvic limbs, no osseous continuity with the primary spinal column, a colonic diverticulum extending to the supernumerary pelvis, an enlarged left kidney with a ureter connecting to a single bladder, right renal aplasia, a single descended testicle in the primary scrotum, an intra-abdominal cryptorchid testicle, and two unidentifiable soft tissue masses. At surgery, a single ileum was present with a primary and accessory cecum and colon and the accessory colon entering the supernumerary pelvis. The accessory cecum and colon, right kidney, two unknown soft tissue masses, and the single descended testicle were removed. The right kidney had a ureter that anastomosed with the accessory colon at its entry into the supernumerary pelvis. The supernumerary pelvis and hind limbs were not removed. Five months after surgery, the dog was reported to be doing well clinically. Caudal duplication is extremely rare in veterinary medicine. The appearance of supernumerary external structures may indicate internal connections as well.
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Affiliation(s)
- Janet A Grimes
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Adrien-Maxence Hespel
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Robert C Cole
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - A Ray Dillon
- From the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
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Muhelo AR, Montemezzo G, Da Dalt L, Wingi OM, Trevisanuto D, Gamba P, Pizzol D, Cavaliere E. Successful management of a parasitic ischiopagus conjoined twins in a low-income setting. Clin Case Rep 2018; 6:385-390. [PMID: 29445482 PMCID: PMC5799649 DOI: 10.1002/ccr3.1374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/05/2022] Open
Abstract
Ischiopagus parasites are fetal defects attached to a relatively normal twin by pelvis. This is the first reported case of parasitic ischiopagus twins without prenatal diagnosis successfully managed in Mozambique. A multidisciplinary team was involved in the supernumerary limbs excision. After 7 months, the infant has a normal development.
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Affiliation(s)
| | - Genni Montemezzo
- Pediatric Surgery Unit Women's and Children's Health Department University of Padova Padova Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health University of Padova Padova Italy
| | | | | | - Piergiorgio Gamba
- Pediatric Surgery Unit Women's and Children's Health Department University of Padova Padova Italy
| | - Damiano Pizzol
- Operational Research Unit Doctors with Africa Beira Mozambique
| | - Elena Cavaliere
- Department of Woman's and Child's Health University of Padova Padova Italy.,Operational Research Unit Doctors with Africa Beira Mozambique
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Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Russameecharoen K, Nawapun K, Phithakwatchara N. Three-dimensional ultrasound for prenatal assessment of conjoined twins: additional advantages? J Perinat Med 2017; 45:667-691. [PMID: 28231064 DOI: 10.1515/jpm-2016-0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
Conjoined twins are a rare, but serious, complication of monozygotic twins. Early prenatal diagnosis of conjoined twins is increasingly made with transvaginal ultrasound and color Doppler studies. Most prenatally diagnosed conjoined twins are terminated due to the high perinatal mortality, but advancement in pediatric surgery has allowed for successful postnatal separation in a small number of cases, and some parents may consider this option over termination of pregnancy. It is important to get a detailed prenatal ultrasound for the site and extent of fusion for an accurate categorization. Three-dimensional ultrasound (3DUS) provides images that can facilitate counselling for the parents. Additional information that impacts on diagnosis, prognostication, and perinatal management of conjoined twins could be obtained from selective use of 3DUS, particularly those with atypical fetal union. Most of the proposed additional benefits of 3DUS are based on case reports. Magnetic resonance imaging (MRI) has been increasingly used for the purpose of identifying intricate organ sharing. Because of the rarity of this condition, and the heterogeneity of fetal fusion, added benefits of either 3DUS or MRI for prenatal diagnosis and perinatal management of conjoined twins have not been demonstrated by well-conducted clinical trials. This article aims to review clinical application of various 3DUS display modes in prenatal assessment of conjoined twins, focusing on their potential additional benefits, risks and misuses. 3DUS may help detecting additional findings that are not possible with 2DUS, but, it has not been scientifically shown to improve the survival rate of the twins or reduce maternal morbidity.
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Fullerton BS, Sparks EA, Hall AM, Velazco CS, Modi BP, Lund DP, Jaksic T, Hendren WH. High prevalence of same-sex twins in patients with cloacal exstrophy: Support for embryological association with monozygotic twinning. J Pediatr Surg 2017; 52:807-809. [PMID: 28202184 DOI: 10.1016/j.jpedsurg.2017.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/23/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Previous studies have hypothesized that cloacal exstrophy may be caused by errors early in embryological development related to monozygotic twinning. This study reports the prevalence of twins in a large cohort of patients with cloacal exstrophy. METHODS Patients with cloacal exstrophy treated 1974-2015 were reviewed for reports of multiple gestation or conjoined twinning. The genetic sex of the patient and their twin, and any mention of anomaly in the twin were recorded. Neither placental exam nor genetic testing results were available to definitively determine zygosity. RESULTS Of 71 patients, 10 had a live born twin (14%), all of whom were of the same genetic sex as the affected patient. One additional patient's twin suffered intrauterine fetal demise, and another patient had a conjoined heteropagus twin. None of the twins were affected by exstrophy-epispadias complex. The rate of twin birth in this cohort was 4.4-7.7 higher than that reported by the Centers for Disease Control in the general population time period (P<0.001), with a striking preponderance of same-sex pairs. CONCLUSIONS The highly significant prevalence of same-sex twin pairs within this cohort supports the hypothesis that the embryogenesis of cloacal exstrophy may be related to errors in monozygotic twinning. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Brenna S Fullerton
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Eric A Sparks
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Amber M Hall
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Cristine S Velazco
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Biren P Modi
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Dennis P Lund
- Stanford University Department of Surgery and Lucile Packard Children's Hospital, 725 Welch Road, Palo Alto, CA 94304, USA
| | - Tom Jaksic
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - W Hardy Hendren
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
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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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Abstract
Conjoined twins are rare, but well-described, anomalies. The heteropagus (parasitic) variant, in which there is a fully functioning autosite and a partially formed parasite, is even more rare. Typically, patients with this condition are discovered and treated as neonates or infants. We present an unusual case of an ischiopagus patient presenting at 17 years of age, which appears to be the oldest recorded presentation for surgery of a heteropagus twin in the English literature. The patient had two additional developed lower extremities along with two additional rudimentary upper extremities. The challenges and lessons learned from this rare and complex surgery are discussed.
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Ademuyiwa A, Alabi E, Idiodi-Thomas H, Bankole O, Elebute O, Alakaloko F, Desalu I, Bode C. Surgical management of pygopagus parasiticus in a developing country: Challenges and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Kubyshkin VA, Krieger AG, Smirnov AV, Akhmedov BG, Gushcha AO, Kopyl'tsov AA, Volkov SK, Nerestyuk YI, Kalinin DV, Mariyko VA, Romanova NN. [Radical removal of parasitic twin in 29-years-old patient]. Khirurgiia (Mosk) 2015:103-106. [PMID: 26978769 DOI: 10.17116/hirurgia201512103-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V A Kubyshkin
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - A G Krieger
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - A V Smirnov
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - B G Akhmedov
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | | | - A A Kopyl'tsov
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - S K Volkov
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - Ya I Nerestyuk
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
| | - D V Kalinin
- A.V. Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow
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Saikia P, Choudhury D, Kalita K. Oro-facial dysmorphism with visible glossoepiglottic fold in a heteropagus: First description. Indian J Anaesth 2014; 58:223-4. [PMID: 24963199 PMCID: PMC4050951 DOI: 10.4103/0019-5049.130845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Priyam Saikia
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Dipika Choudhury
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Kabita Kalita
- Department of Plastic Surgery, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Calderoni DR, Mizukami A, Nunes PHF, Kharmandayan P. Thoraco-omphalopagus asymmetric conjoined twins: Report of a case and complete review of the literature. J Plast Reconstr Aesthet Surg 2014; 67:e18-21. [DOI: 10.1016/j.bjps.2013.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/27/2013] [Accepted: 06/04/2013] [Indexed: 11/16/2022]
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Pessel C, Fratto V, Laifer-Narin S, Simpson LL, Nhan-Chang CL. Going out on a limb for a difficult diagnosis: a case report. Clin Imaging 2013; 38:63-6. [PMID: 24080370 DOI: 10.1016/j.clinimag.2013.08.013] [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] [Received: 05/15/2013] [Revised: 08/01/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Sacral tumors with fetiform features are rare and pose a diagnostic challenge to the ultrasonologist. Sacrococcygeal teratomas (SCT) and parasitic twins can have very similar sonographic features but have different implications to an affected pregnancy. While postnatal histopathology is ultimately necessary to distinguish between a SCT and a heteropagus twin, certain characteristics, such as the presence of a vertebral column and the pattern and rate of tumor growth, may be useful to guide counseling and management decisions.
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Affiliation(s)
- Cara Pessel
- Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, NY.
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Terata M, Kikuchi A, Kanasugi T, Oyama R, Fukushima A, Sugiyama T. Prenatal diagnosis of parasitic conjoined twins with three-dimensional ultrasound. Congenit Anom (Kyoto) 2013; 53:131-3. [PMID: 23998267 DOI: 10.1111/j.1741-4520.2012.00378.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 05/30/2012] [Indexed: 11/29/2022]
Abstract
Asymmetric and parasitic conjoined twins are extremely rare anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin. Sonographic examination is essential for prenatal diagnosis as early detection of fetal anomalies with poor prognosis provides a chance to deliver the infant vaginally for the mother. We herein describe a case with a prenatal diagnosis of a parasitic twin using three-dimensional (3-D) ultrasound. The clear images obtained with 3-D ultrasound helped in counseling the parents. Making an early prenatal diagnosis of severe fetal anomalies with careful and sophisticated sonographic examinations should be warranted.
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Affiliation(s)
- Miyuki Terata
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Iwate, Japan
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Trainavicius K, Kazlauskas V, Gurskas P. Epigastric heteropagus conjoined twins. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pandey A, Singh SP, Pandey J, Gupta V, Verma R. Lumbosacral parasitic twin associated with lipomeningomyelocele: a rare occurrence. Pediatr Neurosurg 2013; 49:110-2. [PMID: 24526054 DOI: 10.1159/000358096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/18/2013] [Indexed: 02/05/2023]
Abstract
Lumbosacral parasitic twin is an extremely rare entity. About 200 cases have been reported in the literature. It may be associated with neural tube defects. We encountered a 3-day-old female child with this presentation, who was successfully operated on at the age of about 2 months. Being an uncommon entity, it is presented here.
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Affiliation(s)
- Anand Pandey
- Department of Surgery, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, India
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Mutchinick OM, Luna-Muñoz L, Amar E, Bakker MK, Clementi M, Cocchi G, da Graça Dutra M, Feldkamp ML, Landau D, Leoncini E, Li Z, Lowry B, Marengo LK, Martínez-Frías ML, Mastroiacovo P, Métneki J, Morgan M, Pierini A, Rissman A, Ritvanen A, Scarano G, Siffel C, Szabova E, Arteaga-Vázquez J. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:274-87. [PMID: 22002822 DOI: 10.1002/ajmg.c.30321] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Conjoined twins (CT) are a very rare developmental accident of uncertain etiology. Prevalence has been previously estimated to be 1 in 50,000 to 1 in 100,000 births. The process by which monozygotic twins do not fully separate but form CT is not well understood. The purpose of the present study was to analyze diverse epidemiological aspects of CT, including the different variables listed in the Introduction Section of this issue of the Journal. The study was made possible using the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) structure. This multicenter worldwide research includes the largest sample of CT ever studied. A total of 383 carefully reviewed sets of CT obtained from 26,138,837 births reported by 21 Clearinghouse Surveillance Programs (SP) were included in the analysis. Total prevalence was 1.47 per 100,000 births (95% CI: 1.32-1.62). Salient findings including an evident variation in prevalence among SPs: a marked variation in the type of pregnancy outcome, a similarity in the proportion of CT types among programs: a significant female predominance in CT: particularly of the thoracopagus type and a significant male predominance in parapagus and parasitic types: significant differences in prevalence by ethnicity and an apparent increasing prevalence trend in South American countries. No genetic, environmental or demographic significant associated factors were identified. Further work in epidemiology and molecular research is necessary to understand the etiology and pathogenesis involved in the development of this fascinating phenomenon of nature.
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Affiliation(s)
- Osvaldo M Mutchinick
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Departamento de Genética, Registro y Vigilancia Epidemiológica de Malformaciones Congénitas, México City, Mexico.
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