1
|
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.
Collapse
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
| |
Collapse
|
2
|
Poudel D, Shrestha S, Aryal R, Adhikari A, Bajracharya S. Thoraco-omphalopagus conjoined twin: A rare case report. Int J Surg Case Rep 2022; 99:107683. [PMID: 36137433 PMCID: PMC9568746 DOI: 10.1016/j.ijscr.2022.107683] [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: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Conjoined twins epitomize rare phenomenon of monozygotic twinning. Associated with high rates of stillbirth and neonatal demise Recommended mode of delivery is cesarean section. Thoraco-omphalopagus linked with poorer prognosis due to complex cardiac, hepatic and biliary fusion
Collapse
|
3
|
Shah S, Joleya MK, Shukla RM, Laddha A, Sharma SS, Tiwari P, Raj V, Lahoti BK, Joshi M. Tribrachius parapagus diencephalus conjoined twin. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
4
|
Bindlish A, Sawal A. A Detailed Description and Discussion on Conjoined Twins. Cureus 2022; 14:e29526. [PMID: 36312620 PMCID: PMC9595239 DOI: 10.7759/cureus.29526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022] Open
Abstract
Conjoined twins are described as having been physically fused during pregnancy and delivery. They were first mentioned a long time ago when there was not much known about this. They share some organs that are vital for survival, like the heart; these twins are almost impossible to save, but there are some cases wherein there is evidence of their survival. The article aims to present a unique discussion on conjoined twins. This article talks about the formation of conjoint twins, their types and nomenclatures, embryological concepts, past history/traditional tales, case studies, and the medical enhancements happening in this area. Both fission and fusion are thought to contribute to the disease. A monozygotic twin pregnancy cleaves when it occurs more than thirteen days after fertilization. There is just one placenta and one womb for conjoined twins (one amniotic sac). The twins that are born and stay alive after delivery usually stay alive for a few days or weeks. It’s pretty rare for them to live a long prosperous life, but this article shows the otherwise, too, like the Siamese twins, which is a unique example of conjoint twins who lived for a long time. This kind of pregnancy is a complex procedure that needs to be managed by a team of professionals.
Collapse
|
5
|
Muhammad S, Laraswati B, Violetta L. Radiology assessment of omphalopagus conjoined twins: A case report. Radiol Case Rep 2022; 17:1169-1174. [PMID: 35169422 PMCID: PMC8829502 DOI: 10.1016/j.radcr.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 10/26/2022] Open
|
6
|
AbouZeid AA, Mohammad SA, Radwan AB, ElDieb L, El-Gendy YG, Ibrahim H, Amer A, Shabana T, Elzahaby H, Elbarbary A, Saleh M, Abdelaziz TH, Elbeshry S, Abdel-Hay S, El-Ghoneimi A, Zaki A. Ventrally Fused Conjoined Twins (Omphaloischiopagus): A Roadmap to Successful Separation. European J Pediatr Surg Rep 2022; 10:e53-e62. [PMID: 35282302 PMCID: PMC8913179 DOI: 10.1055/s-0042-1743579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/13/2022] [Indexed: 12/05/2022] Open
Abstract
Conjoined twining is one of the most fascinating and challenging situations which a pediatric surgeon may face in his career. Only few surgeons may have the opportunity to share in separation of such cases. In this report, we aim to share our experience with the successful separation of ventrally fused male conjoined twins (omphaloischiopagus). The case was thoroughly studied via preoperative cross-sectional imaging modalities (magnetic resonance imaging [MRI] and computed tomography [CT] angiography), complemented by data obtained from reviewing similar cases in the literature. A clear delineation of the complex anatomy was achieved preoperatively which proved to be well consistent with the operative findings. A detailed description of the operative procedure to divide/redistribute the shared abdominal/pelvic organs between both twins is provided. To the best of our knowledge, this is the first report to describe the detailed and unique internal anatomy of a common central phallus associating ischiopagus conjoined twins. The penis was centrally located in the perineum in between both twins with an open urethral plate. This common phallus had a peculiar configuration with four crura anchoring ischial bones of both twins together.
Collapse
Affiliation(s)
- Amr A AbouZeid
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | | | - Ahmed B Radwan
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Leila ElDieb
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | - Yasmin G El-Gendy
- Department of Pediatrics, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Hanan Ibrahim
- Department of Pediatrics, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Akram Amer
- Department of Anesthesia, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Tarek Shabana
- Department of Anesthesia, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Hany Elzahaby
- Department of Anesthesia, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Amir Elbarbary
- Department of Plastic Surgery, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Mohamed Saleh
- Department of Plastic Surgery, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Tarek H Abdelaziz
- Department of Orthopedics, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Shady Elbeshry
- Department of Orthopedics, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Sameh Abdel-Hay
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré Mother-Child University Hospital, Paris, Île-de-France, France
| | - Ahmad Zaki
- Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt
| |
Collapse
|
7
|
Chaturvedi A, Klionsky N, Biyyam D, Chess MA, Sultan N. Acutely presenting congenital chest lesions: a primer for the radiologist. Emerg Radiol 2022; 29:557-570. [PMID: 35253079 DOI: 10.1007/s10140-022-02035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022]
Abstract
Congenital chest lesions encompass several important entities. Without prompt intervention, many of these can culminate in serious complications. Timely and accurate radiologic interpretation of these entities is integral to patient management. Imaging can help characterize and prognosticate several of these entities, and may both suggest the need for and guide therapy. We overview the clinical presentation, associated complications, imaging characteristics, and prognostic indicators-both postnatal and antenatal-of the spectrum of emergently presenting congenital chest lesions. We also outline current and evolving management strategies, whether fetal, peripartum, or postnatal. The ultimate goal is to help radiologists formulate timely and effective diagnoses of these entities and boost the relevance of their input towards clinical decision-making.
Collapse
Affiliation(s)
- Apeksha Chaturvedi
- Department of Imaging Sciences, Division of Pediatric Radiology, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Nina Klionsky
- Department of Imaging Sciences, Division of Pediatric Radiology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | | | - Mitchell A Chess
- Department of Imaging Sciences, Division of Pediatric Radiology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Nadia Sultan
- Department of Imaging Sciences, Division of Pediatric Radiology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| |
Collapse
|
8
|
AbouZeid AA, Mohammad SA, Zaki AM, AbdelHay S. Separation of pygopagus conjoined twins: What has changed after 15 years. J Pediatr Surg 2022; 57:557-559. [PMID: 34763901 DOI: 10.1016/j.jpedsurg.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Amr Abdelhamid AbouZeid
- Department of Pediatric Surgery, Faculty of Medicine-Ain Shams University, Lotefy el-sayed street, Cairo 11657, Egypt.
| | | | - Ahmed Medhat Zaki
- Department of Pediatric Surgery, Faculty of Medicine-Ain Shams University, Lotefy el-sayed street, Cairo 11657, Egypt
| | - Sameh AbdelHay
- Department of Pediatric Surgery, Faculty of Medicine-Ain Shams University, Lotefy el-sayed street, Cairo 11657, Egypt
| |
Collapse
|
9
|
Conjoined twins: an obstetrician's guide to prenatal care and delivery management. J Perinatol 2021; 41:2424-2431. [PMID: 34158580 DOI: 10.1038/s41372-021-01107-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning. STUDY DESIGN Experiences with two cases of conjoined twins. RESULTS We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction. CONCLUSION After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding.
Collapse
|
10
|
Abstract
With the increasing rate of twin pregnancies due to increase in maternal age and use of assisted reproduction, it is important to be aware of unique diseases which occur specifically to twin pregnancies, especially in monochorionic twin pregnancies. These entities include twin to twin transfusion syndrome, twin anemia polycythemia sequence, twin reversed arterial perfusion, cotwin demise, and conjoined twins. Early evaluation and documentation are imperative to guide management which ultimately leads to better patient outcomes.
Collapse
|
11
|
Rahayatri TH, Amaliah R, Putri NM, Puspaningtyas NW, Karyanti MR, Hendarto A. Omphalopagus conjoined twins separation during coronavirus disease-19 pandemic era: A case report. Int J Surg Case Rep 2021; 84:106150. [PMID: 34221850 PMCID: PMC8240450 DOI: 10.1016/j.ijscr.2021.106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. Case presentation Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. Clinical discussion Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. Conclusion The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight. Omphalopagus conjoined twins separation surgery is an intricate procedure that requires a multidisciplinary team The separation surgery of conjoined twins during the COVID-19 pandemic necessitate a unique surgical preparation and disciplined health protocols. The ideal timing of separation surgery of conjoined twins in the COVID-19 pandemic era remains controversial, factors that may play a role in the decision making include the age, weight, general clinical condition, and the complexity of fusion identified
Collapse
Key Words
- ARDS, acute respiratory distress syndrome
- CDC, Centers for Disease Control and Prevention
- COVID-19
- COVID-19, coronavirus disease-19
- CPAP, continuous positive airway pressure
- CT-scan, computed tomography-scan
- CUSA, cavitron ultrasonic surgical aspirator
- Case report
- Children
- Conjoined twins separation
- ECMO, extracorporeal membrane oxygenation
- HCP, healthcare providers
- HFN, high flow nasal
- HFOV, high-frequency oscillation ventilation
- ICU, intensive care unit
- IVC, inferior vena cava
- MRI, magnetic resonance imaging
- MRSA, methicillin-resistant Staphylococcus aureus
- NPWT, negative pressure wound therapy
- ORC, oxidized regenerated cellulose
- Omphalopagus conjoined twins
- PCR, polymerase chain reaction
- PDA, patent ductus arteriosus
- PDS, polydioxanone suture
- PICU, pediatric intensive care unit
- POD, post-operative day
- PPE, personal protective equipment
- SCARE, surgical case report
- WHO, World Health Organization
- cm, centimeter
- lpm, litres per minute
Collapse
Affiliation(s)
- Tri Hening Rahayatri
- Faculty of Medicine, Universitas Indonesia, Pediatric Surgery Division, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Rizky Amaliah
- Faculty of Medicine, Universitas Indonesia, Pediatric Surgery Division, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nandita Melati Putri
- Faculty of Medicine, Universitas Indonesia, Plastic Surgery Division, Department of Surgery, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Niken Wahyu Puspaningtyas
- Faculty of Medicine, Universitas Indonesia, Pediatric Intensive Care Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mulya Rahma Karyanti
- Faculty of Medicine, Universitas Indonesia, Pediatric Infectious and Tropical Disease Division, Department of Child Health,Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aryono Hendarto
- Faculty of Medicine, Universitas Indonesia, Pediatric Nutrition and Metabolic Disease Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
12
|
KARA T, ŞARA Hİ, ATEŞ F, ÖZLER S, DURMAZ MS. Omfalopagus yapışık ikizlerin intrauterin ve postpartum dönem ultrasonografi ve manyetik rezonans görüntüleme bulgularının sunumu. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.833785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
13
|
Tan MB, Tan KP, Beh JCY, Chan EYK, Chin KFW, Chin ZY, Chua WM, Chong AWL, Gu GT, Hou W, Lai ACY, Lee RZ, Liew PJR, Lim MYS, Lim JLL, Tan Z, Tan E, Tan GSL, Tan TSE, Tan EJ, Tan ASM, Yan YY, Lim WEH. SingHealth Radiology Archives pictorial essay Part 1: cardiovascular, respiratory and neurological cases. Singapore Med J 2020; 61:633-640. [PMID: 33415343 DOI: 10.11622/smedj.2020177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Singapore Health Services cluster (SingHealth) radiology film archives are a valuable repository of local radiological cases dating back to the 1950s. Some of the cases in the archives are of historical medical interest, i.e. cerebral angiography in the workup of patients with hemiplegia. Other cases are of historical social interest, being conditions seen during earlier stages of Singapore's development, i.e. bound feet. The archives form a unique portal into the development of local radiology as well as the national development of Singapore. A selection from the archives is published in 2020 in commemoration of the 20th anniversary of the formation of SingHealth, the 55th National Day of Singapore, and the 125th anniversary of the International Day of Radiology. This pictorial essay comprises cardiovascular, respiratory and neurological cases from the archives.
Collapse
Affiliation(s)
- Mark Bangwei Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Kim Ping Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | | | | | - Zong Yi Chin
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | - Wei Ming Chua
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | | | - Gary Tianyu Gu
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | - Wenlu Hou
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | - Anna Chooi Yan Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | | | - May Yi Shan Lim
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | | | - Zehao Tan
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | - Eelin Tan
- Singhealth Diagnostic Radiology Residency Programme, Singapore
| | | | | | - Eu Jin Tan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Yet Yen Yan
- Department of Radiology, Changi General Hospital, Singapore
| | | |
Collapse
|
14
|
Omran A, Nassif M, Salhab N, Abdo A, Almahmod Alkhalil MA, Taishori N, Dayoub A. Early separation of omphalopagus conjoined twins: a case report from Syria. J Surg Case Rep 2020; 2020:rjz374. [PMID: 32015822 PMCID: PMC6990099 DOI: 10.1093/jscr/rjz374] [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: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 11/13/2022] Open
Abstract
Omphalopagus twins are one of many forms of conjoined twins sharing part of the gastrointestinal system and abdominal wall. This type of twins has the best chance of survival if successfully separated. Surgical approaches in these cases are generally preferably elective, but sometimes separation may be urgently needed due to life-threatening complications, such as hemodynamic instability, death of either twin, necrotizing enterocolitis, among many others. We report a case of successfully separated omphalopagus twins at day two of life.
Collapse
Affiliation(s)
- Ammar Omran
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatric Surgery, Latakia, Syria
| | - Mhmmad Nassif
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatric Surgery, Latakia, Syria
| | - Nabila Salhab
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatric Surgery, Latakia, Syria
| | - Aras Abdo
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatric Surgery, Latakia, Syria
| | | | - Norma Taishori
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatrics, Latakia, Syria
| | - Adnan Dayoub
- Tishreen University Faculty of Medicine, Tishreen University Hospital, Department of Pediatrics, Latakia, Syria
| |
Collapse
|
15
|
Ilyas M, Khan I, Shah S, Saldanha C. Siamese twins: Thoracopagus – A rare congenital anomaly. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmgims.jmgims_60_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
16
|
Grizelj R, Sindičić Dessardo N, Bulić K, Luetić T, Mikulić D, Antabak A, Sjekavica I, Alduk AM, Konosić S, Režek Tomašić K, Ćaleta T, Pleško S, Šarić D, Vuković J. Successful separation of xypho-omphalopagus conjoined twins with extrauterine twin-twin transfusion syndrome: a case report. Croat Med J 2019. [PMID: 31483115 PMCID: PMC6734570 DOI: 10.3325/cmj.2019.60.301] [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] [Indexed: 11/23/2022] Open
Abstract
Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100 000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner.
Collapse
Affiliation(s)
- Ruža Grizelj
- Ruža Grizelj, Department of Pediatrics, University of Zagreb School of Medicine, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Deepak C, Vandana S, Pradeep B, Nikhil K. Anesthetic management of separation of conjoint twins: Challenges and limitations. Saudi J Anaesth 2019; 13:140-143. [PMID: 31007661 PMCID: PMC6448423 DOI: 10.4103/sja.sja_589_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A conjoint twin is a rare congenital anomaly. The separation of conjoint twins presents a unique challenge to anesthesiologists. We report the anesthetic management of successful separation of thoraco-omphalopagus conjoint twins, along with challenges and limitations that we faced in perioperative period. We highlight the importance of a multidisciplinary approach, proper preoperative planning, and perioperative vigilance regarding monitoring and complication.
Collapse
Affiliation(s)
- Choudhary Deepak
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sharma Vandana
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bhatia Pradeep
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kothari Nikhil
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
18
|
Imaging of liver fusion and vascular intra-hepatic shunts in omphalopagus conjoined twins: The role of a double CT study. Clin Imaging 2019; 54:25-30. [DOI: 10.1016/j.clinimag.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022]
|
19
|
Nazir Z, Mateen Khan MA, Faruque AV, Dilawar B. Separation of conjoined twins in a resource constraint setting – Lessons learned and implications for global surgery initiatives. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.09.008] [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
|
20
|
Abstract
Imaging of conjoined twins requires the use of multiple modalities, in both the prenatal and postnatal setting. Prenatal imaging, including both ultrasound and magnetic resonance imaging, benefits from an organized, worksheet-based approach, careful labelling of all images, and adoption of supplemental techniques. Postnatal imaging should be informed by the prenatal imaging findings and should be thoughtfully planned prior to performance. Complete evaluation prior to planned surgical separation will require the use of complementary modalities and multidisciplinary review and discussion.
Collapse
Affiliation(s)
- Amy R Mehollin-Ray
- Department of Radiology, Baylor College of Medicine, Houston, TX, United States; Fetal Radiology, E.B. Singleton Department of Pediatric Radiology and Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States.
| |
Collapse
|
21
|
Bergner EM, Gollins L, Massieu LA, Hurst N, Hair AB. Nutritional considerations in the care of conjoined twins. Semin Perinatol 2018; 42:355-360. [PMID: 30197028 DOI: 10.1053/j.semperi.2018.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conjoined twins represent an interesting nutritional challenge as nutrient delivery and absorption is greatly affected by anatomy and, therefore, unique to each twin pair. Nutritional support is essential to optimize growth and development in the neonatal period; however, very little data exists on the topic in this population. Conjoined twins require individualized nutritional assessment that focuses on the interaction between the metabolic rate, nutrient uptake, and nutrient delivery of each twin in the dyad. This report describes one center's experience with monitoring growth, establishing nutrient requirements, and determining substrate utilization in three sets of conjoined twins.
Collapse
Affiliation(s)
- Erynn M Bergner
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Laura Gollins
- Clinical Nutrition Services, Texas Children's Hospital, Houston, TX, USA
| | - L Adriana Massieu
- Clinical Nutrition Services, Texas Children's Hospital, Houston, TX, USA
| | - Nancy Hurst
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| |
Collapse
|
22
|
Eris Yalcin S, Akkurt MO, Yavuz A, Yalcin Y, Sezik M. Prenatal sonographic diagnosis of cephalopagus conjoined twins at 14 weeks of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:408-411. [PMID: 29064095 DOI: 10.1002/jcu.22550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/22/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
Conjoined twins are extremely rare and are a type of monozygotic twins that occur due to an incomplete embryonic division on postconception day 13 to 15. Eight different types of conjoined twins have been described in the literature. Management of the condition depends on the site and extent of the union. We present a case of cephalopagus twins diagnosed at 14 weeks of gestation.
Collapse
Affiliation(s)
- Serenat Eris Yalcin
- Department of Obstetrics and Gynecology, Division of Perinatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Ozgur Akkurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - And Yavuz
- Department of Obstetrics and Gynecology, Division of Perinatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Yakup Yalcin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Mekin Sezik
- Department of Obstetrics and Gynecology, Division of Perinatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
23
|
Conjoined Twin Separation: Integration of Three-Dimensional Modeling for Optimization of Surgical Planning. J Craniofac Surg 2018; 28:4-10. [PMID: 27977489 DOI: 10.1097/scs.0000000000003412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Conjoined twinning is a rare anomaly, with an incidence of approximately 1 in 100,000 live births. There is a high perinatal mortality rate, but twins who survive pose reconstructive challenges that require meticulous preoperative planning. The authors describe the senior surgeon's career experience with conjoined twin separation, and the evolution of medical modeling and 3-dimensional imaging as a critical component in presurgical planning.The authors performed a retrospective review of all consecutive patients of conjoined twin separation at a single institution from January 2004 to December 2013. Data were collected related to patient demographics, comorbidities, operative technique, perioperative complications, survival, long-term outcomes, and the type of medical modeling system used for preoperative planning.Five sets of conjoined twins underwent separation during the 10-year study period. There were 3 sets of thoraco-omphalopagus twins, 1 set of pyopagus twins, and 1 set of ischiopagus tetrapus twins. The mean age at separation was 70 days, with a mean of 3.5 surgical procedures performed per patient during the first year of life. One set of twins experienced postseparation complications that warranted immediate return to the operating room. The overall survival rate after separation was 70%. The imaging methods used were computed tomography scan with 3-dimensional reconstruction, plaster molds, medical modeling with composite printing, and virtual surgical planning.The use of imaging and medical modeling in presurgical planning has proven to be an important element in optimizing the outcomes for patients with this rare anomaly.
Collapse
|
24
|
Mathew RP, Francis S, Basti RS, Suresh HB, Rajarathnam A, Cunha PD, Rao SV. Conjoined twins - role of imaging and recent advances. J Ultrason 2017; 17:259-266. [PMID: 29375901 PMCID: PMC5769666 DOI: 10.15557/jou.2017.0038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management. MATERIAL AND METHODS This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound. Only one case was further evaluated by MRI. RESULTS Three cases of conjoined twins (cephalopagus, thoracopagus and omphalopagus) were accurately diagnosed on antenatal ultrasound. After detailed counseling of the parents and obtaining written consent, all the three cases of pregnancy were terminated. Delivery of the viable conjoined twins was achieved without any complications to the mothers, and all the three conjoined twins died after a few minutes. CONCLUSION Ultrasound enables an early and accurate diagnosis of conjoined twins, which is vital for obstetric management. MRI is reserved for better tissue characterization. Termination of pregnancy when opted, should be done at an early stage as later stages are fraught with problems. Recent advances, such as 3D printing, may aid in surgical pre-planning, thereby enabling successful surgical separation of conjoined twins.
Collapse
Affiliation(s)
- Rishi Philip Mathew
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore 575002, Karnataka, India
| | - Swati Francis
- Department of Obstetrics & Gynaecology, Yenepoya Medical College, Deralakatte 575018, Karnataka, India
| | - Ram Shenoy Basti
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore 575002, Karnataka, India
| | - Hadihally B. Suresh
- Department of Radio-Diagnosis, Father Muller Medical College, Mangalore 575002, Karnataka, India
| | - Annie Rajarathnam
- Department of Obstetrics & Gynaecology, Yenepoya Medical College, Deralakatte 575018, Karnataka, India
| | - Prema D. Cunha
- Department of Obstetrics & Gynaecology, Father Muller Medical College, Mangalore 575002, Karnataka, India
| | - Sujaya V. Rao
- Department of Obstetrics & Gynaecology, Father Muller Medical College, Mangalore 575002, Karnataka, India
| |
Collapse
|
25
|
Fusaro MV, Becker C, Pandya S, Mcbride W, Alizadeh K, Iannotti V, Zelkovic P, Barst S, Tobias ME, Mohan A, Freda J, Gewitz M, Scurlock C. International teleconsultation on conjoined twins leading to a successful separation: a case report. J Telemed Telecare 2017; 24:482-484. [DOI: 10.1177/1357633x17715377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conjoined twins are identical twins that have incompletely separated in utero. The prognosis for conjoined twins is poor and management in a skilled tertiary care centre is paramount for definitive care. We describe our experience with a telemedical consultation on conjoined twins in The Dominican Republic from our eHealth centre in Valhalla, NY. The patients were two month old, female, pygopagus conjoined twins. A multidisciplinary teleconference was initiated with the patients, their family, the referring paediatrician and our team. Based on this teleconsultation, the team felt as though the twins may be amenable to a surgical separation. They presented to our centre in Valhalla, NY, for a detailed physical examination and series of imaging studies. Soon after, the patients underwent a successful 21 h separation procedure and were discharged 12 weeks later. To our knowledge, this is one of the first reports of an international teleconsultation leading to a successful conjoined twin separation procedure.
Collapse
Affiliation(s)
- Mario V Fusaro
- Center for eHealth, New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Christian Becker
- Center for eHealth, New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Samir Pandya
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Whitney Mcbride
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Kaveh Alizadeh
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | - Vicki Iannotti
- New York Medical College, Valhalla, NY, USA
- Department of Pediatrics, Maria Fareri Childrens Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Paul Zelkovic
- New York Medical College, Valhalla, NY, USA
- Department of Urology, Westchester Medical Center, Valhalla, NY, USA
| | - Samuel Barst
- New York Medical College, Valhalla, NY, USA
- Department of Anesthesia, Westchester Medical Center, Valhalla, NY, USA
| | - Michael E Tobias
- New York Medical College, Valhalla, NY, USA
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Avinash Mohan
- New York Medical College, Valhalla, NY, USA
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Jeffrey Freda
- New York Medical College, Valhalla, NY, USA
- Department of Anesthesia, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Gewitz
- New York Medical College, Valhalla, NY, USA
- Department of Pediatrics, Maria Fareri Childrens Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Corey Scurlock
- Center for eHealth, New York Medical College, Valhalla, NY, USA
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
- Department of Anesthesia, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
26
|
Mian A, Gabra NI, Sharma T, Topale N, Gielecki J, Tubbs RS, Loukas M. Conjoined twins: From conception to separation, a review. Clin Anat 2017; 30:385-396. [PMID: 28195364 DOI: 10.1002/ca.22839] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/27/2022]
Abstract
Conjoined twins are suggested to result from aberrant embryogenesis. The two main theories proposed to explain the phenomena are fission and fusion. The incidence rate is 1 in 50,000 births; however, since about 60% of the cases are stillborn, the true incidence is approximated at 1 in 200,000. There is a higher predisposition towards female than male gender with a ratio of 3:1. Conjoined twins are classified based upon the site of attachment. The extent of organ sharing, especially the heart, determines the possibility and prognosis of a separation procedure. Meticulous preoperative evaluation, planning, and preparedness of the team are crucial for a successful separation. Separation of conjoined twins poses several technical, legal, and ethical issues. Clin. Anat. 30:385-396, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Asma Mian
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Nader Ishak Gabra
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Tanuj Sharma
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Nitsa Topale
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Jerzy Gielecki
- Department of Anatomy, Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Poland
| | | | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| |
Collapse
|
27
|
Parasitic twin--a supernumerary limb associated with spinal malformations. A case report. Acta Neurochir (Wien) 2016; 158:611-4. [PMID: 26811301 DOI: 10.1007/s00701-016-2710-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
We describe a case of rachipagus parasitic twin with spinal cord malformations (lipomyelomeningocele and tethered cord) in a 7-month-old Ethiopian infant. The parasitic mass had a well-formed foot, ankle and lower leg and a small sinus that resembled an anus. Magnetic resonance imaging scans revealed spinal malformations including a distal syringohydromyelia. The mass was successfully resected and the dural attachment was closed. Histopathological examination confirmed the diagnosis. Postoperatively, the child had unchanged, intact neurological function in both lower limbs. Almost all rachipagus parasitic twins are associated with spinal malformations. They should, therefore, be operated on by surgeons experienced in myelomeningocele surgery.
Collapse
|
28
|
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.
Collapse
|
29
|
Abstract
Conjoined twins represent a great challenge for most pediatric specialists including pediatric surgeons, anesthetists, neonatologists, urologists, neurosurgeons, and orthopedic surgeons. This anomaly can be classified according to the type of twins׳ fusion. Various organs can be fused making the separation difficult. Conjoined twins are usually diagnosed antenatally by ultrasound. Detailed fetal echocardiography is necessary to counsel the parents during pregnancy. Postnatally, the majority of the conjoined twins can be thoroughly investigated using various imaging techniques. This allows careful planning of the operation. However, in approximately one-third of the patients an urgent operation is required at birth without a complete assessment of the joining. This is associated with a poorer outcome.
Collapse
Affiliation(s)
- Agostino Pierro
- Division of general and thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, Ontario, Canada M5G 1X8.
| | - Edward M Kiely
- Hospital for Children NHS Trust Great Ormond Street, London, England, UK
| | - Lewis Spitz
- Ex-Great Ormond Street Hospital & Institute of Child Health, London, England, UK
| |
Collapse
|
30
|
Abstract
The pediatric urologists role is confined to ischio-, para-, and pygopagus conjoined twins. The aim is to preserve renal function, to address problems with urinary continence, and to optimize genital issues with particular reference to sexual and reproductive function. Full urological imaging is essential prior to separation for planning and for the operation itself.
Collapse
Affiliation(s)
- Peter Cuckow
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK.
| | - Pankaj Mishra
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| |
Collapse
|
31
|
Abstract
Imaging plays a key role in the management of conjoined twins. Pre-operative multi-modality studies are vital to assess operability and to aid surgical planning. Technical advances in imaging such as high-resolution isovolumetric magnetic resonance imaging (MRI) techniques and three-dimensional modeling now result in extremely accurate anatomical information. Varied information from a comprehensive radiological work-up enables the surgeons to plan the safest possible operative procedure, helps the anesthetic team before and during surgery, and guides the intensive care team in the post-operative phase. This article will review the radiological techniques used in our institution, highlighting potential pitfalls with the various imaging modalities.
Collapse
Affiliation(s)
- Sarah G Watson
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
| |
Collapse
|
32
|
Prenatal Diagnosis of Cephalophagus Conjoined Twins by Ultrasonography and Magnetic Resonance Imaging. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Pal R, Arora KK. Colostomy in an ischiopagus, 3(rd) PND conjoined twins with cross-circulation: Anaesthetic management. Indian J Anaesth 2014; 58:345-7. [PMID: 25024487 PMCID: PMC4091010 DOI: 10.4103/0019-5049.135083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rashmi Pal
- Department of Anesthesiology, MGM Medical College, Indore, Madhya Pradesh, India
| | - Kishore K Arora
- Department of Anesthesiology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
| |
Collapse
|
34
|
Abstract
Conjoined twins are rare, with a reported incidence of 0.19 per 10,000 pregnancies in Europe. We discuss four spontaneous conjoined twin pregnancies presenting to a tertiary referral centre from 2005 to 2011, diagnosed on antenatal dating ultrasound. The cases were monitored closely throughout pregnancy by a multidisciplinary team, with serial surveillance, including ultrasound, fetal echocardiography, magnetic resonance imaging, amniocentesis and further referral to cardiology and paediatric surgery specialists, where indicated. Three female sets were determined antenatally to be not surgically separable; these infants were managed palliatively following a live birth. The male set of conjoined twins was accepted for surgical separation at Great Ormond Street Hospital, London, which was successfully performed electively at 4 months. Of interest, all four parents reside within 20 km of each other, representing a possible cluster of cases. The incidence of conjoined twins in our local population is approximately 0.63 per 10,000 over an 8-year period from 2005 to 2012. This case series highlights a cluster of conjoined twins, managed to viability and delivered in a tertiary referral centre.
Collapse
Affiliation(s)
- C M McCarthy
- Anu Research Centre, Department of Obstetrics and Gynaecology, Cork Universtity Maternity Hospital, University College Cork , Cork , Republic of Ireland
| | | |
Collapse
|
35
|
Bekiesinska-Figatowska M, Herman-Sucharska I, Romaniuk-Doroszewska A, Jaczynska R, Furmanek M, Bragoszewska H. Diagnostic problems in case of twin pregnancies: US vs. MRI study. J Perinat Med 2013; 41:535-41. [PMID: 23612626 DOI: 10.1515/jpm-2012-0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 03/15/2013] [Indexed: 11/15/2022]
Abstract
AIM To present an experience with twin pregnancies underlining the impact of magnetic resonance imaging (MRI) on diagnosis and management. METHODS There were 17 cases of twin pregnancies: nine monochorionic [including four monochorionic diamniotic and five monochorionic monoamniotic (conjoined twins)] and eight dichorionic. The MRI examinations were performed between 19 and 39 weeks of gestational age in two centers using 1.5 T scanners (GE Signa Excite and GE Signa HDxt; GE Healthcare, Waukesha, WI, USA), always after ultrasound (US). In the first period of our activity, SSFSE sequence in T2-weighted images (SSFSE/T2WI) was the main diagnostic tool supported by TSE or GRE T1-weighted images (T1WI). After upgrading the scanners, diffusion-weighted imaging (DWI), steady-state free precession (FIESTA), and echoplanar GRE imaging (EPIGRE) became available. RESULTS In 11 cases (64.7%), MRI was superior to US and supplied additional information, including two cases in which pathology of the second twin suspected on US was ruled out on the basis of MRI. In six cases (35.3%) MRI confirmed US diagnosis and brought no new data. CONCLUSION MRI offers more detailed assessment of fetal pathology in cases of twin pregnancies, including conjoined twins, in which sonographic evaluation is more difficult than in single cases.
Collapse
|
36
|
Singh M, Jacob R, Naik V, Baines D. Separation of thoraco-omphalopagus twins in a rural secondary hospital: Perioperative management. Indian J Anaesth 2013; 56:442-7. [PMID: 23293382 PMCID: PMC3530998 DOI: 10.4103/0019-5049.103957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Providing anaesthesia for the separation surgery of conjoined twins presents unique challenges to the managing anaesthesiologists. The low incidence of such surgeries and anatomical variations in each type of conjoined twins makes each separation surgery a unique experience. This report features the anaesthetic plan and challenges faced in performing the separation surgery of a set of thoraco-omphalopagus twins in a rural secondary hospital in a remote location in India.
Collapse
Affiliation(s)
- Madhurita Singh
- Department of Anaesthesiology, Padhar Hospital, PO Padhar, Dist Betul, Madhya Pradesh, India
| | | | | | | |
Collapse
|
37
|
Multimodality imaging in the assessment of thoraco-omphalopagus conjoined twin: lessons to learn. Case Rep Radiol 2012; 2012:564036. [PMID: 22792503 PMCID: PMC3390032 DOI: 10.1155/2012/564036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 05/23/2012] [Indexed: 11/17/2022] Open
Abstract
Conjoined twins are rare and present a unique challenge to pediatric surgeons and radiologists. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and other associated abnormalities is important for surgical planning and prognostic information. A conjoined female twin with a combined weight of 2.8 kg was born by emergency caeserean. Hence, a computed tomography scan of the thorax and entire abdomen at 1.25 mm slice thickness was performed to delineate the internal structures of the twins. CT-angiography defined specific vascular supply which determined the distribution of shared structures between the twins. An echocardiogram showed four heart chambers with atrioventricular septal defect. To further evaluate the heart chambers, the twin was planned for gated cardiac magnetic resonance imaging. Unfortunately, they succumbed 6 hours apart due to complication of septicemia. Magnetic resonance imaging and CT scan provide excellent anatomic detail, demonstrating organ position, shared viscera, and limited vascular anatomy, whilst angiography defined specific vascular supply, useful in determining the distribution of shared structures between the twins in planning for surgery.
Collapse
|
38
|
Wen X, Parajuly SS, Lu Q, Xiang B, Jiang X, Tang H, Luo Y. Thoraco-omphalopagus conjoined twins: impact of ultrasound assessment on successful surgical separation. Clin Imaging 2012. [PMID: 23206620 DOI: 10.1016/j.clinimag.2012.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this case report, we present a case of thoraco-omphalopagus conjoined twins who were successfully separated and had long-term survival. We performed ultrasound assessment and found that the twins shared the liver and that the fusion site of their liver had gross communication of blood vessel. Ultrasound cardiogram examination showed that the anomalous vessels that connected their hearts drained from the number 1 infant to the number 2 infant. The ultrasound assessment has significant impact on the successful surgical separation of the thoraco-omphalopagus twins.
Collapse
Affiliation(s)
- XiaoRong Wen
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | | | | | | | | | | | | |
Collapse
|
39
|
Ohashi A, Tsuji S, Kuroyanagi Y, Kinoshita Y, Kaneko K, Mine K, Hamada Y, Inagaki T. Multidetector computed tomography angiography for successful surgical separation in pygopagus conjoined twins. Pediatr Int 2012; 54:150-2. [PMID: 22335328 DOI: 10.1111/j.1442-200x.2011.03406.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Atsushi Ohashi
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships. Surg Endosc 2011; 26:1777. [DOI: 10.1007/s00464-011-2069-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022]
|
41
|
Gilbert C, Babyn P. MR imaging of the neonatal musculoskeletal system. Magn Reson Imaging Clin N Am 2011; 19:841-58; ix. [PMID: 22082741 DOI: 10.1016/j.mric.2011.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Experience in magnetic resonance (MR) imaging of the neonatal musculoskeletal system is rapidly increasing. The exquisite ability of MR to image the soft tissues, especially cartilage, without radiation is its key strength. Although it is not practical or sensible to undertake MR imaging in conditions in which radiography and ultrasound provide adequate information, MR is proving to be a useful adjunct and problem-solving tool in many neonatal musculoskeletal conditions.
Collapse
|
42
|
Sudha L, Dev B, Kamble R, Joseph S. Role of biplane digital subtraction angiography, and 3D rotational angiography in craniopagus twins: A case report, detailed pictorial evaluation, and review of literature. J Pediatr Neurosci 2011; 4:113-6. [PMID: 21887192 PMCID: PMC3162776 DOI: 10.4103/1817-1745.57330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Cranially conjoined twins (craniopagus) are regarded as one of the rarest human malformations. Craniopagus represents 2 to 6% of conjoined twins and is the rarest type of disorder. A conventional angiogram with three dimensions is needed to confirm the exact extent of sharing of the arterial / venous tree. 3D angiography was first proposed by CORNELIUS and advanced into clinical practice by VOIGT in 1975. We present a case of craniopagus vertical type II twins, evaluated for cerebral circulation.
Collapse
Affiliation(s)
- Lakshmi Sudha
- Department of Radiology and Imaging Sciences, Sri Ramachandra University, Chennai - 600 116, India
| | | | | | | |
Collapse
|
43
|
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.
Collapse
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.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Takae S, Izuchi S, Murayama K, Kondo H, Kobayashi Y, Ishizuka B. Two cases of pregnancy involving conjoined twins, with details of management after opting for live birth. J Obstet Gynaecol Res 2011; 37:1478-83. [DOI: 10.1111/j.1447-0756.2011.01534.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Osmanağaoğlu MA, Aran T, Güven S, Kart C, Ozdemir O, Bozkaya H. Thoracopagus conjoined twins: a case report. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:238360. [PMID: 21660094 PMCID: PMC3099464 DOI: 10.5402/2011/238360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 11/03/2010] [Indexed: 12/05/2022]
Abstract
Objective. Conjoined twin is a rarely seen congenital anomaly together with severe mortality and morbidity. The more common types of conjoined twins include the thoracopagus type, where the fusion is anterior, at the chest, and involves the heart. We are reporting one case of conjoined thoracopagus twins diagnosed by ultrasonography at 11 weeks. Case Report. In a multigravid pregnant woman who has been admitted to our clinic with a diagnosis of conjoined twins, thoracopagus, by ultrasonography at an 11-week gestation, termination of the pregnancy was performed. Conclusion. Making an early diagnosis with ultrasonographic examination gives the parents a chance to elect pregnancy termination.
Collapse
Affiliation(s)
- Mehmet A Osmanağaoğlu
- Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon 61080, Turkey
| | | | | | | | | | | |
Collapse
|
46
|
Ultrasound diagnosis of cephalopagus conjoined twin pregnancy at 29 weeks. Biomed Imaging Interv J 2010; 6:e38. [PMID: 21611074 PMCID: PMC3097803 DOI: 10.2349/biij.6.4.e38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/01/2010] [Accepted: 09/04/2010] [Indexed: 12/26/2022] Open
Abstract
The authors report a case of a cephalopagus conjoined twin that was diagnosed at 29 weeks of gestation despite the mother having had two ultrasounds done previously. The fetus had one head and face, fused thoraces, common umbilicus but had two pelvises and two sets of genitalia. The fetus had four normally formed legs and arms. Antenatal ultrasound images are supplemented by post natal photographs. A review of literature, clues to ultrasound diagnosis and possible causes of missing this significant abnormality until the 3rd trimester are discussed.
Collapse
|
47
|
Ogutu D, Anastasakis E, Chi C, Kadir RA. First trimester diagnosis of conjoint (pygopagus) twins: A case report of successful prenatal and postnatal management. J OBSTET GYNAECOL 2009; 28:340-2. [DOI: 10.1080/01443610802054899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
48
|
Prenatal diagnosis of thoracopagus fetus: a case report with brief review of literature. Arch Gynecol Obstet 2009; 280:1025-7. [PMID: 19319547 DOI: 10.1007/s00404-009-1054-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 03/10/2009] [Indexed: 10/21/2022]
Abstract
Conjoined twins are uncommon and refer to monozygotic, monoamniotic and monochorionic twins with varying degree and sites of fusion between the twins. In this report, we illustrate a case of thoracopagus twins highlighting the prenatal sonographic and magnetic resonance imaging appearance. Emphasis is laid on the role of appropriate imaging strategy in prognostic assessment and postnatal surgical treatment planning of these cases.
Collapse
|
49
|
|
50
|
Abstract
Craniopagus twins represent a rare phenomenon of congenital misfortune. Modern neurosurgical techniques have created opportunities for successful separation and the promise of a normal existence for these children, who in the past were often left as historical footnotes or put on display as oddities of nature. The authors document a brief history of conjoined twinning and discuss the modern science of craniopagus epidemiology, classification, and separation. In particular, the strategies used and the rationale for staged surgical separation are highlighted.
Collapse
Affiliation(s)
- Samuel R Browd
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Medical Center, University of Utah Health Sciences Center, Salt Lake City, Utah 84113, USA
| | | | | |
Collapse
|