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Zhu W, Cui X, Wu Z, Li Z, Chen G, Liang S, Mao J. Case report: Epigastric heteropagus twins and literature review. Front Pediatr 2023; 11:1088480. [PMID: 37124189 PMCID: PMC10132136 DOI: 10.3389/fped.2023.1088480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Epigastric heteropagus twins are an extremely rare congenital anomaly of conjoined twins. We present a case of epigastric heteropagus twins who were diagnosed via prenatal ultrasound imaging: the fetus (or host) was connected to the abdominal wall of the parasite (the dependent portion), and an omphalocele was present. The male infant was delivered by cesarean section at 35 + 5 weeks gestation. The parasite lacked a head and heart and presented long bones of the limbs. After abdominal computed tomography, omphalocele repair, and parasite removal were surgically performed under general anesthesia. After discharge (follow-up, 3 months), the infant is currently growing well and is healing satisfactorily. Forty-one cases of epigastric heteropagus twins were retrieved from database searches: 38 good postoperative outcomes, 2 perioperative deaths, and 1 termination. The case highlights that even when parasites are massive in size, births can present good outcomes with suitable surgical treatment.
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Affiliation(s)
- Wenbin Zhu
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Xiongjian Cui
- Department of Neonatal Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhaohan Wu
- Department of Neonatal Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhaolin Li
- Department of Neonatal Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Gang Chen
- Department of Neonatal Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Suixin Liang
- Department of Neonatal, Shenzhen Children's Hospital, Shenzhen, China
- Correspondence: Jianxiong Mao Suixin Liang
| | - Jianxiong Mao
- Department of Neonatal Surgery, Shenzhen Children's Hospital, Shenzhen, China
- Correspondence: Jianxiong Mao Suixin Liang
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2
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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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3
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Falyoun MS, Mashlah Q, Aldiri Q, Mohamad AR, Daowd LK, Ayash M. Epigastric heteropagus and omphalocele. J Surg Case Rep 2020; 2020:rjaa437. [PMID: 33133510 PMCID: PMC7590534 DOI: 10.1093/jscr/rjaa437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of epigastric heteropagus twins with omphalocele. The parasite had two lower limbs, genitalia with developed phallus and scrotum but absent testis and absent anus. An omphalocele was present just below the attachment of the parasitic twin. No kidney or ureter but only a bladder filled with urine seen during exploration. The parasite bowel was attached to an omphalocele sac prolapsing through it and there was connection to the autosite liver, which forms the main source of its blood supply. Surgery was performed in the neonatal period (Day 12 after birth) for both excision of epigastric heteropagus and omphalocele repair.
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Affiliation(s)
| | - Qusai Mashlah
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
| | - Qusai Aldiri
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
| | | | | | - Malek Ayash
- Department of Pediatric Surgery, Children Hospital, Damascus, Syria
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4
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Fernández JÁ, Marín GM, Tocuyo YE. Gemelo Heterópago. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los gemelos parásitos o heterópagos son aquellos unidos asimétricos con partes deformes del parásito que se unen en diferentes regiones del gemelo normal (autosite), del cual depende para su soporte nutricional y crecimiento. Presentamos el caso de un gemelo heterópago con las extremidades inferiores y rudimentos de las superiores del parásito unidas al periné y glúteo derecho del autosite. Aunque no compartían órganos pélvicos, la compresión extrínseca de estructuras óseas del parásito causaron estenosis del recto, lo que obligó a la corrección quirúrgica. Los estudios por imágenes permitieron planificar la cirugía, lo cual facilitó la separación exitosa y lograr la sobrevida del paciente con muy buena calidad de vida. A pesar de ser reportados desde épocas ancestrales, aún generan gran interés debido a la variabilidad en su presentación clínica y al desconocimiento en su etiopatogénesis.
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Malik M, Bahadur Singh U, Hedge S, Mahajan JK, Samujh R. Omphalocele and epigastric heteropagus: implications and treatment. Oxf Med Case Reports 2018; 2018:omy074. [PMID: 30302264 PMCID: PMC6169197 DOI: 10.1093/omcr/omy074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/14/2018] [Accepted: 08/06/2018] [Indexed: 11/17/2022] Open
Abstract
In heteropagus twins, the parasitic twin is incompletely formed which is attached to the autosite. We report a case of epigastric heteropagus twins with omphalocele. The parasite had two lower limbs, a rudimentary upper limb, genitalia with developed phallus and scrotum but absent testis. An omphalocele was present just below the attachment of the parasitic twin. A single kidney with ureter and a bladder filled with urine seen during exploration. The parasite bowel was attached to a sleeve of liver tissue from the autosite within the omphalocele sac and this connection was also the main source of its blood supply. Less than 20 cases of omphalocele with EH have been reported previously. The thin sac with underlying adherent bowel led us to go ahead with surgery in the neonatal period for both, excision of epigastric heteropagus and omphalocele repair. The rectus sheath around the omphalocele sac helped in the final wound closure.
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Affiliation(s)
- MuneerAbas Malik
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Umesh Bahadur Singh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Hedge
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Mahajan
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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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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7
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Epigastric heteropagus associated with an omphalocele and double outlet right ventricle. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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8
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Ozkan-Ulu H, Yilmaz Y, Sari FN, Altug N, Uras N, Dilmen U. An unusual case of heteropagus: autosite with a complex cardiac malformation. Pediatr Neonatol 2011; 52:358-60. [PMID: 22192266 DOI: 10.1016/j.pedneo.2011.08.011] [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: 02/16/2010] [Revised: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 10/15/2022] Open
Abstract
Asymmetrical form of conjoined twinning (heteropagus) is an extremely rare event with an incidence of 1-2 million live births. The incomplete component of heteropagus, namely, parasite, usually consists of rudimentary organs. Therefore, the autosite component of heteropagus can be separated successfully. A wide spectrum of associated congenital cardiac malformations, which are usually minor, has been described in autosites. However, a single-ventricle heart anomaly in the autosite has been reported in a very few cases. We report an unusual case of heteropagus with a complex cardiac malformation. To the best of our knowledge, this is the third heteropagus case in the literature with a single-ventricle heart in the autosite.
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Affiliation(s)
- Hulya Ozkan-Ulu
- Division of Paediatric Surgery, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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9
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The epigastric heteropagus conjoined twins. J Pediatr Surg 2011; 46:417-20. [PMID: 21292102 DOI: 10.1016/j.jpedsurg.2010.09.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/20/2022]
Abstract
Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.
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Heteropagus (parasitic) twins: a review. J Pediatr Surg 2010; 45:2454-63. [PMID: 21129567 DOI: 10.1016/j.jpedsurg.2010.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/21/2022]
Abstract
Heteropagus, or "parasitic," twins are asymmetric conjoined twins in which the tissues of a severely defective twin (parasite) are dependent on the cardiovascular system of the other, largely intact twin (autosite) for survival. The estimated incidence of heteropagus twins is approximately 1 per 1 million live births. Isolated case reports comprise most of published work on this rare congenital anomaly. In the past, review articles have focused narrowly on one particular anatomical subtype of parasitic twin and/or on the anatomicopathology observed. Here, we present the epidemiology, proposed pathoembryogenic origins, anatomical abnormalities, management, and outcomes of the wide array of heteropagus twins described in the English language literature.
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Jain P, Borwankar SS, Parelkar S, Mishra P. Parasitic omphalopagus with cranioencephalic malformation and rudimentary cardio-pulmonary system. Indian J Pediatr 2010; 77:704-5. [PMID: 20454937 DOI: 10.1007/s12098-010-0071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Ozturk H, Otcu S, Ozturk H, Duran H. Umbilical heteropagous twinning: a case report. Fetal Pediatr Pathol 2007; 26:255-60. [PMID: 18363158 DOI: 10.1080/15513810701818411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heteropagous conjoined twins are rare and umbilical heteropagous conjoined twins are extremely rare. We present a case with umbilical heteropagous conjoined twins and discuss the diagnosis and management. The parasitic component of heteropagous can be separated and treated successfully in the majority of cases.
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Affiliation(s)
- Hayrettin Ozturk
- Medical School, Department of Pediatric Surgery, Abant Izzet Baysal University, Bolu, Turkey.
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Kanamori Y, Tomonaga T, Sugiyama M, Hashizume K, Goishi K, Haga N. Bizarre Presentation of Epigastric Heteropagus: Report of a Case. Surg Today 2006; 36:914-8. [PMID: 16998686 DOI: 10.1007/s00595-006-3275-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
We report an unusual case of epigastric heteropagus in a female neonate. The parasite had a single lung as well as a liver, stomach, intestine, pancreas, ovaries, a single kidney, and a bladder. These visceral organs were located in the abdominal and pelvic space of the autosite, and the pelvic bone and lower legs of the parasite were fused with the respective organs in the autosite. The infant underwent operations to remove the central leg and some of the intra-abdominal organs of the parasite, but she must still undergo further surgery to remove the genitourinary organs and pelvic bones of the parasite, and repair her very abducted and rotated right leg.
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Affiliation(s)
- Yutaka Kanamori
- Departments of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Tokyo 113-8655, Japan
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Abstract
Conjoined twins are rare, heteropagus conjoined twins are rarer, and epigastric heteropagus conjoined twins are rarer still. It refers to unequal and asymmetrical twinning in which the dependant component (parasite) is smaller and attached to the epigastrium of the dominant component (autosite). We report 3 cases of epigastric heteropagus conjoined twinning. A review of literature is presented along with a discussion of possible etiopathogenesis.
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Affiliation(s)
- Manish Bhansali
- Pediatric Surgery Unit, NSCB Medical College, Jabalpur (M.P.), 482003, India
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Ribeiro RC, Maranhão RFA, Moron AF, Leite MTC, Cordioli E, Hisaba W, Martins JL. Unusual case of epigastric heteropagus twinning. J Pediatr Surg 2005; 40:E39-41. [PMID: 15793712 DOI: 10.1016/j.jpedsurg.2004.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Asymmetrical conjoined twins or heteropagus twins are extremely rare. They are characterized by an incomplete component (parasite) that is normally smaller and dependent on the host (autosite). In cases of an epigastric heteropagus twin, the insertion occurs in the epigastrium. There are few reports of epigastric heteropagus twinning in the English-language literature. The authors report an extremely rare case of epigastric heteropagus twinning in which the parasite presented with head, thorax, and a rudimentary heart.
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Abstract
The authors report a rare case of asymmetric conjoined twins in which the incomplete parasitic twin was attached to the lumbar area of the autosite. The parasitic twin had well-formed bony pelvis, both lower limbs, partial genitourinary, and gastrointestinal tracts. The parasitic twin was excised, and the exomphalos was repaired.
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Affiliation(s)
- J K Mahajan
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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