Thoracophagus Conjoint Twins: A Case Report

Bangladesh Journal of Medical Science, 1970

A patient at her 38+ wks of pregnancy as a ultrasonographically diagnosed case of conjoined twin admitted in our department with ruptured membrane. Two live female babies joined at the chest were delivered by caesarean section. The parents refused a separation operation and the mother and the babies were discharged from hospital at 6th post natal day. A review of the literature suggests that early diagnosis by a combination of ultrasound and MRI is essential for management as it provides prognosis for viability and process of surgical separation and also the opportunity for early counseling of parents and termination if indicated. Key world: Conjoined twins; thoracopagus; prenatal diagnosis; separation procedure DOI: http://dx.doi.org/10.3329/bjms.v10i4.9504 BJMS 2011; 10 (4): 289-292

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015

Conjoined twins are a rare occurrence with an incidence of about 1 in 100000 pregnancies. Our case is that of a 32 year old multigravida patient who came to us at 17 weeks gestation with a scan done at 14 weeks suggestive of severe spinal dysraphism with lumbar meningomyelocele spina bifida at multiple levels with protuberant abdomen. The patient opted for medical termination of pregnancy which was carried out after due to consent. The patient aborted after 12 hours. Further inspection of the abortus revealed it to be conjoined twins with one apparently normal head and thorax with a large omphalocele with 4 lower limbs. There were two caudal halves along with two sets of lower limbs and external genitalia arising from the abortus perpendicular to it on either side of the thorax. One set of arms was attached to the thorax and yet another arm and a limb bud were arising from the other end of the fetus attached to a rudimentary head like structure. Heteropagus tetrapus twins are an extremely rare form of parasitic twins. Inspite of advances in surgical techniques and methods, the morbidity endured by the affected neonates is very high. Thus prenatal diagnosis of conjoined twins along with the option of termination of pregnancy is of utmost importance.

Journal of the Turkish German Gynecological Association, 2010

reviewed the database and medical records of 857 twin pregnancies, including 140 monochorionic twins. Nineteen monochorionic-monoamniotic twin pregnancies were detected, four of which were complicated by conjoined twins. Results: Of these 4 cases, 2 were complicated by thoracopagus and one had thoraco-omphalopagus; these three cases underwent termination at 16, 11, and 19 weeks gestation, respectively. The last case was diagnosed as a pygopagus tetrapus parasitic twin at 28 weeks gestation. The family decided to continue the pregnancy, and achieved a successful outcome with elective surgery postpartum. Conclusion: Conjoined twins are an uncommon and complex complication of monozygotic gestations, which is associated with high perinatal mortality. The early prenatal diagnosis of conjoined twins allows improved counseling about the management options, including maintenance of pregnancy with surgery after delivery or termination of pregnancy.

International Journal of Advanced Research (IJAR), 2025

Conjoined twins are an extremely rare form of monozygotic twinning, with an estimated incidence of between 1 in 100,000 and 1 in 250,000 live births, and are rarely encountered by obstetricians. Prompt diagnosis and management are essential, as around 70% of conjoined twins die within 48 hours of birth or present with lethal congenital malformations. We report the case of a thoraco-omphalopagus twin pregnancy terminated at 13 weeks amenorrhea.

Obgynia, 2024

Introduction: Thoraco-omphalopagus conjoined twins are a rare occurrence of monozygotic pregnancy that involves fusion of the anterior thorax and abdomen. This type presents a variety of cardiac anomalies, which contribute to its generally unfavorable prognosis. Case Presentation: A 32-year-old multigravida with Gravida 6, Para 4, and Abortus 1 was referred at 28 weeks of gestation. Ultrasonography revealed thoracoomphalopagus-conjoined twins in which the fetuses joined ventrally. Prenatal MRI revealed the sharing of a single liver, omentum, and diaphragm. Partial fusion was observed in the sternal bone, pericardium, and anterior wall of the hearts, but with separated heart chambers and unsynchronized heartbeats. Classical cesarean section was performed at 38 weeks of gestational age. Histopathology revealed a single placenta with one umbilical cord, suggesting monochorionic-monoamniotic pregnancy. Healthy female babies were born with a combined weight of 5400 g. Post-delivery echocardiography revealed a cardiac anomaly characterized by malposition of the great arteries in a twin. After 13 h of close monitoring in the NICU, the twins died due to cardiac complications. Conclusion: The management of pregnancy involving thoraco-omphalopagus conjoined twins requires a comprehensive and multidisciplinary approach aiming to provide holistic care, addressing complex medical risks, and ethical dilemmas associatedwith these twins.

International Journal of Women's Health and Reproduction Sciences, 2015

A 28-year-old, gravida 2, para 1, pregnant woman was referred to our tertiary perinatal center at a gestational age of 9 weeks and 6 days with presumptive diagnosis of conjoined twins. She had no relevant family and medical history. After detailed ultrasonographic examination, twins were joined at the thorax (thoracopagus). There was separate 2 heads, a common heart and one umbilical cord (Figure 1C). In the view of

Journal of Perinatal Medicine, 1989

Bangabandhu Sheikh Mujib Medical University Journal, 2012

Conjoined twins are a rare and complex complication of monozygotic twinning, which is associated with high perinatal mortality. One of the commonest defects of blastogenesis is monozygotic twinning resulting in separate or conjoint twins. The latter includes category of internal, "endoparasitic," or fetus-in-fetu twins. 1 Conjoined twinning only arises when the twinning event occurs at about the primitive streak stage of development, at about 13-14days after fertilization, and is exclusively associated with monoamniotic monochorionic type. Conjoined twins (also known as Siamese twins) are identical twins whose bodies are joined in utero. It is a rare phenomenon, the occurrence is estimated to range from 1 in 50,000 to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. 2 Approximately half are stillborn, and a smaller fraction of pairs born alive having abnormalities which is incompatible with life. The overall survival rate for conjoined twins is approximately 25%. The condition is more frequently found among females, with a ratio of 3:1. 2 Two contradicting theories exist to explain the origins of conjoined twins. The older and most generally accepted theory is fission, in which the fertilized egg splits partially. The second theory is fusion, in which a fertilized egg completely separates, but stem cells (which search for

Journal of Nepal Medical Association

Conjoined twins (Siamese twins) represent the rarest form of twin pregnancy. Reported here are two rare cases of conjoined term twins presented to the department of Obstetrics and Gynaecology within 3 months. The first case, 32 years of gravida 6 parity 5 referred from periphery after full trial of labour following multi-organ dysfunction and term intrauterine dead twins. Intraoperatively it was dead conjoined thoraco-omphalopagus females. The patient died after 3 days following multiorgan dysfunction syndrome and disseminated intravascular coagulation. The second case, 22 years gravida 2 parity 1 also referred from periphery in second stage of labour with diagnosis of 39 weeks intrauterine dead twins with obstructed labour, delivered by caesarean with intraoperative conjoined dead females of thoracophagus type. Twins are high-risk pregnancy. This rare diagnosis with complications could have been prevented by regular antenatal checkups, ultrasonography performed by radiologists and ...

Case Reports in Pathology, 2012

Thoracoomphalopagus is the commonest type of conjoined twin where the bodies are fused from upper chest to lower chest. The autopsy done can help counsil the parents for further pregnancies and determine the prognosis depending upon the type of cardiac anomaly by Seo classification when detected antenatally. We describe the detail pathological autopsy of such a case with single heart and single liver. A detail autopsy was done on the twin fetus. The twins shared a single heart and sometimes the liver and part of digestive system. The combined weight was 4.1 KG. Both were full-term male babies joined from below the nipple till umbilicus. Autopsy in conjoined twins helps in deciding the type of fusion of the body and also of the heart and great vessels. It can help in counseling parents about future pregnancies that there is no chance of recurrence of this abnormality and no need to be scared.

2011

Background: The aim of this study was to determine the accuracy of prenatal echocardiography in the diagnosis of intracardiac malformations and the degree of cardiac fusion in conjoined twins presenting to a single center over a 25-year period.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Thoraco-omphalopagus asymmetric conjoined twinning is a rare condition in which a grossly defective foetus (the parasite) is attached to the thorax and upper abdomen of the main foetus (the autosite). We describe a case of thoraco-omphalopagus asymmetric conjoined twins in which the autosite had an associated large-diameter omphalocoele that was successfully separated at our institution. Reconstruction of the resulting abdominal-wall defect was performed using a flap from the gluteal region and the proximal portion of the inferior limb of the parasite, which is demonstrated. In addition, a review of all previously published cases is presented, showing that overall positive results can be obtained in treating this condition and that the presence and degree of cardiac involvement have a major influence on the prognosis.

2021

Background: Conjoined twins are a rare type of monoamniotic twins, estimated to occur in 1.5 per 100,000 births worldwide [1]. The incidence appears remarkably similar throughout the world, although the report is higher from Atlanta 1 per 20,000 births [2]. When twins are conjoined, the fusion occurs between the same body parts. Conjoined twins are classified as cephalopagus, thoracopagus, omphalopagus, ischiopagus, parapagus, craniopagus, rachipagus and pygopagus based on the site of fusion. Case Report: Here we report a case of a 27-year-old Gravida 4 para 2 Abortion 1 mother who presented with labor and rupture of membrane. She had two previous cesarean deliveries. She did not have ultrasound scanning throughout her pregnancy. She was in active labor and an emergency Cesarean section was done. Conjoined twin (Thoraco-omphalopagus) was diagnosed during surgery when the fetuses were extracted from the uterus intra-operatively. Conclusion: The case of thoraco omphalopagus conjoined ...

American Journal of Obstetrics and Gynecology, 1976

International Journal of Biomedical Research, 2013

Conjoined twins is one of the rarest forms of twin gestation. The reported incidence varies from 1 in every 200 identical twin pregnancies to 1 in 50 000 to 1 in 100 000 live births. Majority of cases reported in literature were diagnosed in first trimester of pregancy and have undergone termination on parents request in view of poor fetal outcome. We report a case of live thoraco omphalopaguspagus conjoined twins, presented at 36 weeks of geatation with breech presentation, weighing 4.2 kg, delivered by elective caesarean section. Babies were sharing heart and greater vessels. Babies were referred to cardio thoracic centre for further evaluation and surgical intervention.Parents were counselled about the possible adverse perinatal outcome.