Surgical experience with conjoined twins

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 ...

Ankara Üniversitesi Tıp Fakültesi Mecmuası, 2011

A 29-year old woman, gravida 2, para 1 was referred for routine scan at 12 weeks. Sonographic examination performed at 12 gestational weeks revealed conjoined twins. The fetal biometry of both twins was consistent with the menstrual age. The upper and lower limbs of both twins were normal. Fetuses were positioned face-to-face and fused from umbilicus to lower thorax. Fetuses were found to share the heart and liver. One fetus had cystic hygroma. The parents opted to terminate the pregnancy but refused autopsy.

European Heart Journal Supplements, 2014

The aim of the study is to describe varieties of congenital heart disease (CHD) in different types of conjoined twins (ConTw). This is a retrospective (from 1997 to 2014) analysis of 42 sets of ConTw with different levels of body and/or organ fusion, referred to our center for cardiac evaluation prior to separation. Conjoined twins were classified into Classes 1, 2, and 3 according to heart abnormalities and further subclasses of a, b, and c according to minor or major heart disease. Of the 42 sets, there were 35 sets of twins (83.3%) who were symmetrical including 3 craniopagus, 3 pygopagus, 14 thoracopagus, 11 omphalopagus, 3 ischiopagus, and 1 parapagus. Seven sets of twins (16.7%) were asymmetrical with a variable degree of thoraco-omphalo-ischiopagus fusion. Twenty-six of 40 sets (65%) were female. Overall incidence rate of cardiac abnormalities was 76.2%. Major cardiac abnormalities were common in thoracopagus twins (14 sets). Two sets (14%) shared the pericardium, whereas three sets (21.5%) were fused at atrial level, two sets (14%) at ventricle level, and seven sets (50%) had a severely malformed single heart with fusion at both the atrial and ventricular level. Conjoined twins have a high incidence of CHD. All symmetrical thoracopagus tetrapus twins had major cardiac abnormalities precluding their separation and all of them did not survive. Incidence of major cardiac malformations was less in the other types of ConTw.

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.

Medical Science

Conjoined twins are a relatively uncommon congenital anomaly with a significant mortality and morbidity rate. Twins who are conjoined are the thoracopagus variation is one of the most common types of conjoined twins, in which the fusion is anterior, at the chest and affects the heart. We describe a case of a 19 years old primigravida who delivered conjoined twins by thoracopagus. A pregnant woman who had reached full cervical dilatation was admitted to the delivery room. She had an ultrasound, which revealed bigeminal pregnancy with two breech-presented foetuses that were perhaps conjoined twins. The foetus' dimensions determined by ultrasound corresponded to a gestational age of 22 weeks. The first foetus' heart rate was roughly 40 beats per minute, while the second foetus' heart rate was imperceptible. She delivered herself by manually extracting the foetuses. Unable to show any signs of life, one male and one female foetus were delivered. The cause of death was determined by autopsy to be thoracophagus.

African journal of reproductive health, 2009

Conjoined twins represent one of the rarest forms of congenital abnormalities. We present a case of conjoined twins delivered at born in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon. They were joined at the chest and abdomen, and had one functional heart. The outcome was fatal on the seventh day of life, despite appropriate reanimation measures. This case highlights the difficulties inherent in the diagnosis and management of conjoined twins in low resource settings.

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 Clinical Ultrasound, 1992

Asian Cardiovascular and Thoracic Annals, 2001

A case of thoracopagus twins with conjoined hearts and livers is described. The female twins were delivered in the 19th week of gestation. There was a common pericardial sac and the hearts were joined at the atrial and ventricular levels. Prenatally, surgical separation was considered impossible due to the fused heart, which was confirmed by the autopsy findings.

Open Journal of Pediatrics

Introduction: The birth of conjoined twins is an event extremely rare that offers unique therapeutic challenges and circumstances. We must examine each situation with the many questions that arise and which sometimes require a long reflection. We report a case of separation of pygopages conjoined twins as well as a review of the literature. Patients and Observations: A pair of conjoined twins aged 11 days, weighing 3080 g between them, was referred to the neonatology department from the Faranah prefecture, 300 km from Conakry, for care. The mother, a 30-year-old housewife, multipara, eight gestures and nine parities, had not followed any prenatal consultation. The delivery took place at home in a village with the death of the mother immediately postpartum. The clinical and paraclinical investigation had concluded with the diagnosis of Siamese type pygopage. After multidisciplinary consultation, the surgical treatment by separation of the twins was carried out at the age of 50 days with success and preservation of the physiological functions. Conclusion: The birth of conjoined twins is extremely rare. Each pair of Siamese is different and the surgical strategy must be adapted according to the shared organs. The perfect multidisciplinary work of the medical staff has been the main contributor to our success.

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.

Journal of Chitwan Medical College, 2019

A 27 years old primigravida woman at 19 weeks of gestation was came for routine antenatal checkup in Chitwan Medical College was diag­nosed as twin pregnancy with thoracophagus conjoined twin. The fetal biometrics of both were consistent with the gestational age. Fetuses were found with fusion of the skin contour, at the level of the lower chest with complex appearing fused cardiac near midline and liver ap­pears separate. Both fetal heads were in breech presentation facing faces with each other at the same level. Bilateral upper and lower limbs were identified in both fetuses with same gender. The parents decided to terminate the pregnancy but refused autopsy.

International Journal of Surgery Case Reports, 2020

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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.

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.