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Fetus in fetu is a rare congenital anomaly in which a malformed parasitic twin is found within the body of a living child or adult. In this case report, a 1-day-old child presented with a large firm abdominal mass on the left side of the upper abdomen. Imaging studies misdiagnosed the mass as an intraperitoneal benign dermoid cyst displacing the bowel loops and internal viscera. A surgical resection was performed on 21 days of life, and pathology confirmed eight fetuses inside the cyst. [ABSTRACT FROM AUTHOR]

The birth of babies sharing body part(s) and surviving independently is indeed a scientific marvel. Conjoined twinning is a rare phenomenon with various presentations, having an estimated incidence of 1 per 200,000 live births. The successes recorded by experts in developed countries in the separation of conjoined twins in recent times, especially among those with complex unions are indeed fascinating. The management of conjoined twins presents a great challenge to medical and surgical teams in tropical African countries such as ours where we are faced with challenges of limited resources and facilities, even amidst the presence of well-trained experts. The incidence of conjoined twins is difficult to report in our practice because of failures that accompanied previous cases that were managed and not reported. This is the first successful separation after two previous failed attempts at our center. We report a case of successful surgical separation of thoraco-omphalopagus conjoined twins who were undiagnosed prenatally and delivered by emergency cesarean section following prolonged labor by a primiparous woman. Babies were joined from the lower chest and the upper abdomen and they shared a single umbilicus and omphalocele sac. No internal viscus was shared apart from the torso wall. They were cared for from 12 h of live until 127 days of live when they were successfully separated by a team of medical and surgical experts. This is a report of a successful separation of conjoined twins at the University of Ilorin Teaching Hospital in North Central Nigeria. Careful interdisciplinary conduct of expert activities will ensure the survival of rare congenital malformations such as conjoined twinning even in underdeveloped climes. [ABSTRACT FROM AUTHOR]

Introduction: Conjoined twin is an extremely rare condition and requires a thorough knowledge of anatomy, and a multidisciplinary approach is essential to successfully separate the twins. Thoracopagus twins lie face to face and are attached from chest to upper abdomen. They are the most common among all the varieties but have a poor survival rate. Materials and Methods: This study is a review of literature from 2019 to the oldest via PubMed and Google Scholar using keywords: Conjoined twins, Thoracopagus twins, Thoracoomphalopagus and Thoraco-omphalopagus twins. The articles were reviewed for the description of the anatomy of shared organs, management and outcome of these twins. Results: One hundred and fifty-eight sets of thoracopagus and thoraco-omphalopagus twins including our twins were included in this study. Out of 158 reported thoracopagus twin sets in literature, with M: F ratio of 1:2.3, 71 sets were found to be non-operable and all of them subsequently expired; 82 sets were operated upon, out of which 83 babies survived, suggesting an overall surgical success rate of about 50%. Conclusion: Thoracopagus twins have a dismal prognosis. The most important decisive parameter for successful separation is the extent of sharing of organs between twins. The role of a motivated multidisciplinary team is also indispensable and cannot be overemphasised. [ABSTRACT FROM AUTHOR]

Background: Parasitic conjoined twin is a rare but well-known entity with unclear embryopathogenesis. Abnormal conjoined twinning can result in an externally attached parasitic twin (PT), an enclosed foetus in foetu, or a mature teratoma. The treatment requires complete excision and reconstruction of local anatomy which is not always straightforward.Materials and Methods: PT cases presenting over 12 years were analysed. Patients with complete data, histopathological diagnosis and follow-up were included in the study. During follow-up, specific complications and related investigations were considered.Results: A total of five patients at four different sites were identified: two retroperitoneal foetus in foetu and three externally attached PTs which were located in the lumbar region, sacrococcygeal area and on the lower anterior abdominal wall. All patients underwent complete surgical excision. In foetus in foetu cases, the blood supply was directly from the aorta with a short stump while the three externally located ones required meticulous and careful dissection with the reconstruction of local anatomy.Conclusion: Parasitic conjoined twinning can present at different sites and surgical challenges vary accordingly. For surface lesions, reconstruction may be as complicated as excision. Prognosis can be affected by the excellence of anatomical restoration. Long-term follow-up is essential to address problems specific to the site of lesion and method of surgical reconstruction. [ABSTRACT FROM AUTHOR]

Conjoined twin is an extremely rare condition and needs a thorough knowledge of anatomy and a multidisciplinary approach is essential to successfully separate, the twins. Thoracopagus are the twins attached by chest and umbilicus and are the commonest among all the varieties but carries a poor survival rate. We describe our approach and experience of management of thoracopagus twins who were separated at eighty-three day of life and are alive and well after 4 years of follow up. The most important decisive parameter for successful separation is the extent of sharing of organs between twins but the role of a motivated multidisciplinary team is also indispensable. [ABSTRACT FROM AUTHOR]

Conjoined pygopagus accounts for about 17% of all conjoined twins and commonly share the gluteal region, terminal spine, lower gastrointestinal, urological, and reproductive tracts. This makes their separation a very challenging task. We report herein pygopagus twins who had minimal fusion in coccygeal region and could be separated without a complicated procedure. The case is being reported to add to the literature and emphasize that simple fusion in conjoined twins can be relatively easy to manage. [ABSTRACT FROM AUTHOR]

Twin pregnancies are associated with multiple birth defects. The increase in twinning was attributed to fertility treatments. Twins were supposed to be associated with increased risk of congenital malformations. Among the twins, monozygotic twins were associated with more malformations then dizygotic twins. Heteropagus conjoined twins are asymmetrical conjoined twins where one twin is normal and the other is anatomically incomplete and grossly defective, attached externally, with or without internal connection. Heteropagal Conjoined twins were classified based on the site of their union, and when the fusion occurs at the level of the spine it is called Rachipagal heteropagal twin. One of the most important complication of Monochorionic placenta is Twin to twin transfusion syndrome. The major major defect is in recipient twin there was lack of well developed cardiac structure, and the blood supply was maintained through placental vascular anastomosis with normal twin. This sequence was described as the twin reversed arterial perfusion ,also known as Acardiac Twinning. Here we are going to present two rare cases of Rachipegal Heteropagal twin and Acardiac twin. [ABSTRACT FROM AUTHOR]

Conjoined twins are one of the most fascinating human malformations. Here, we report the anesthetic management and challenges faced in performing the successful separation surgery of 4-day-old thoraco-omphalopagus conjoined twins, born at term to a multigravida by elective caesarean section weighing 3.5 kg with APGAR score of more than 7. Computerized tomography scan revealed fused anterior surface of the left lobe of liver with common left portal vein. Confirmation of cross-circulation between the twins was done by giving intravenous midazolam to one of the conjoined twins, but no effect seen in the other one. We highlighted the responsibility of anesthesia team in anesthetizing sequentially the two patients who are joined together, technical difficulty of intubating the twins facing each other, need of careful monitoring, anticipation of complications such as massive blood loss, hemodynamic instability, desaturation, and hypothermia, and preparedness for their management and vigilant postoperative care. [ABSTRACT FROM AUTHOR]

Following the qualification of Dr Adejuyigbe as a bona fide paediatric surgeon in 1985, Prof Bankole, retired but not tired, became the pioneer Registrar for the National Postgraduate Medical College of Nigeria. - Prof MA Bankole 4th APSON Lecture: The hands that rock the cradle rules the world. Ife 2004 My first contact with Prof Bankole was during the 4th Association of Paediatric Surgeons of Nigeria (APSON) conference held in Ile Ife. [Extracted from the article]

We have three MRI suites in one complex and all are equipped with MRI compatible anesthesia workstations. We noticed that the anesthesia workstation of MRI suite-II did not have compatible gas pipeline connection to be fitted in suite-I. There was no separate compatible tubing to connect the workstation to wall gas outlets. Dear Editor, Anesthesia management for magnetic resonance imaging (MRI) of conjoined twins poses challenges to deal with two infants simultaneously, unfamiliar environment, limited space and personnel.[[1]] Providing anesthesia for MRI to conjoined twins is a rare opportunity that requires two MRI compatible anesthesia workstations. [Extracted from the article]

Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis. Surgical separation of these cases can be an elective procedure or an emergency, mandated by the death of one of the twins. Surgical separation of craniopagus twins is a complex exercise needing detailed evaluation and planning. For the successful management of these twins, a multi-disciplinary approach involving neurosurgeons, plastic surgeons, anesthetists, radiologists, pediatric critical care specialists and ancillary staff is mandatory. We present a case of partially successful elective separation of partial angular craniopagus twins performed in 2002.The surviving twin was managed conservatively for a cerebrospinal fluid leak. The patient subsequently developed a pseudomeningocele, necessitating re-exploration, excision of the gliotic tissue, and repair of the dura and the overlying scalp flap. The patient has a skull defect for which cranioplasty has been deferred. The child is neurologically intact. The post-operative evaluation and the detailed periodic neurological assessment till date (with a follow up of 15 years) have been presented in this study. [ABSTRACT FROM AUTHOR]

Introduction: Conjoined twins are abnormalities of twinning in which two individuals are incompletely separated. Conjoined twins can be symmetric or asymmetric and continue to raise significant ethical and legal arguments, resulting in much pressure on the managing teams and hospitals. Patients and Methods: We report 4 cases of conjoined twins, an ischiophagus dipus, pygophagus, thoracoomphalophagus tetrapus, and a parasitic twin tripus. All cases had no prenatal diagnosis and were delivered via spontaneous vaginal delivery. The pygophagus tetrapus was separated and a mortality of 50% was recorded in the immediate post separation period; the surviving twin is 8 years old and doing well. Two were lost due to severe birth trauma, and the last was lost to overwhelming from an infected gluteal congenital defect. Results and Discussion: Conjoined twins are one of the most fascinating congenital malformations not only to the medical practitioners but to communities and general public also. To our knowledge, as of 2012, only 15 cases have been reported from Nigeria. The incidence is 1:50,000-1:100,000 births. Females are affected more frequently than males by a ratio of 3:1. Separation of conjoined twins is a complicated procedure. The importance of a multidisciplinary team approach with several rehearsals of all aspects (surgical, anesthetic intensive care, transfer from the theatre to intensive care unit, and nursing) of the operative procedure cannot be overemphasized. Conclusion: Conjoined twins are one of the most fascinating congenital malformations. Early prenatal diagnosis, antenatal care, choice of mode of delivery, thorough assessment of the extent of shared organs to guide decisions on surgical separation, adequate planning, and rehearsals can reduce morbidity and mortality in these patients. In our series, all pregnancies and deliveries were unsupervised leading to poor outcome. [ABSTRACT FROM AUTHOR]

Dr. Mohammed El Gammal MD 8th November 1951-25th January 2022 Dr. El Gammal's name has been closely linked to the development of anesthesia for conjoined twins' separation in Saudi Arabia. [INLINE:1] It is with great sorrow that the Saudi Anesthesia Community has received the news of the passing away of Dr. Mohammed El Gammal, a prominent figure in the field of Anesthesiology in Saudi Arabia. [Extracted from the article]

Conjoined twins are a rare congenital anomaly of unknown aetiology. We report the successful anaesthetic management of separation of ischiopagus tetrapus conjoined twins. The importance of a multidisciplinary approach, thorough pre-operative evaluation and planning, vigilant monitoring and anticipation of complications such as massive blood and fluid loss, haemodynamic instability, hypothermia and intensive, post-operative care are emphasised. [ABSTRACT FROM AUTHOR]

Heteropagus twins are an extremely rare event with an incidence of 1-2 million live births that represents, sometimes, a real challenge for paediatric surgeons. The majority of cases have complete or partial duplication of the pelvis and/or lower extremities. Thoracic heteropagus conjoined twins is a rare condition in which a grossly defective foetus (the parasite) is attached to the thorax of the main foetus (the autosite). We describe a case of a parasitic heteropagus attached at the chest wall with a rare presentation of giant exomphalos on the autosite. In this situation, the separation procedure was simple after a well-done anatomic study using X-ray, ultrasonography, magnetic resonance and echocardiogram are performed. [ABSTRACT FROM AUTHOR]

The most common type is the thoracopagus joined at the thorax, followed by xiphopagus, omphalopagus, pyopagus, ischiopagus, and craniopagus.[[1]] We describe the procedural sedation for two pyopagus twin sister infants, aged 6 weeks, weighing 5.2 kg (approximately 2.5-2.8 kg each) posted for magnetic resonance imaging (MRI) of the spine [Figure 1]. One aliquot of intravenous midazolam was required for twin A but not for twin B. The whole MRI procedure took an hour with stable haemodynamics and saturation. [Extracted from the article]

Parasitic twin is a rare form of conjoined twins with an incidence ranging from 1 in 50,000 to 1,00,000 live births. In thoracopagus type, both hearts are joined together and often are associated with underlying congenital cardiac malformations. The separation surgery is a challenging task for both the surgeon as well as anesthetist due to the complexity of the procedure and long duration of surgery, carrying mortality close to 100% in case of significant cardiac fusion. Here, we are sharing anesthetic management of successful separation of a rare type of parasitic male conjoined twins who had connected hearts and common liver. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins. We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date. We highlight the responsibility of anaesthesia team in anaesthetising the two individual patients simultaneously, need of careful monitoring and anticipation of complications like massive blood loss, hypotension, hypokalemia, hypoxia and hypercabia. Detailed description of successful management is reported. [ABSTRACT FROM AUTHOR]

Background: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27th week. She had had five previous ultrasound scans that gave conflicting results. Materials and Methods: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. Results: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patient's request. The patient did well postpartum and was discharged on the 5th postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. Conclusion: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Epigastric heteropagus twin is a rare form of parasitic twins. Though heart defects may be found in 28% of these babies, an association with situs inversus and dextrocardia is extremely uncommon. We present a rare case of epigastric heteropagus twinning with dextrocardia and situs inversus. [ABSTRACT FROM AUTHOR]

The article presents a case study of anaesthetic management of the three day-old male twins for colostomy in tetrapus variety of ischiopagus with cross-circulation. It says the x-ray reveals two separate spines and pelvic bones, which were conjoined. It mentions that each twin had received paracetamol injection and were extubated in paediatric intensive care unit.

Female conjoined twins (thoraco-omphalopagus) were delivered by emergency caesarean section in a private nursing home. On examination, one of the twins was dead and was threatening the survival of the surviving twin (twin A). An emergency separation was performed to salvage the surviving twin. [ABSTRACT FROM AUTHOR]

Conjoined twins have been viewed with fascination since antiquity. There are numerous reports in the literature documenting anesthetic management strategies for the separation of conjoined twins. There are also reports in the literature detailing anesthetic approaches for surgical procedures not involving separation. This is the first report of the anesthetic management of a set of omphalagous presenting for palliative repair of omphalocele in Nigeria. [ABSTRACT FROM AUTHOR]

One of the most interesting congenital malformations is that of conjoined twins. We report echocardiographic features of twin heart in dicephalus, tribrachius, dispinous, thoracoomphalopagus twin. It showed two hearts fused at atrial level. Right-sided heart had single atrial chamber with a single ventricle. A single great vessel, aorta, originated from it. Left-sided heart was well developed with two atria and two ventricles. There was a small mid muscular ventricular septal defect and a small patent ductus arteriosus. Great arteries had normal origins. [ABSTRACT FROM AUTHOR]

During evaluation of a partial Siamese twin for removal of nonviable parasitic part in an 8-year-old male child, a fully functional kidney was found. The functional status of the extra kidney was found to be within acceptable limits for the purpose of transplant, which was subsequently done in a 24-year-old patient with end-stage renal disease. The recipient is healthy 19 months after the surgery. The possibility of using organs from a partial Siamese twin makes this a unique case report. [ABSTRACT FROM AUTHOR]

There is no record of both separated ischiopagus tetrapus conjoined twins leading normal lives 22 years after separation. We separated a pair of such twins in 1986 and have followed them up till date. Details regarding the technique of separation and the procedures required to ensure normal defecation and micturition and normal musculoskeletal function have been described by us in earlier communications. In this paper we describe their present status and ability to face the world as independent adult females. The outcome reflects the responsibilities and dedication of pediatric surgeons for infant patients with congenital problems after they have become adults, taking a pivotal role to involve surgeons of other disciplines as and when necessary. [ABSTRACT FROM AUTHOR]

Xipho-omphalopagus twins are conjoined twins sharing some part of gastrointestinal system and lower sternum. These types of twins have best chances of survival if successfully separated. We report a case of successfully separated Xipho-omphalopagus twins, highlighting the importance of proper planning and team effort in such separations. [ABSTRACT FROM AUTHOR]

A parapagus set of male conjoined twins was brought to our institution at 12 h after birth. An extensive sharing of the abdominal viscera (single liver, hindgut), abdominal aorta, pelvis (single rectum and anus), genitalia (one set) and vertebral column was found. The surgical separation was not considered due to medical and ethical issues. [ABSTRACT FROM AUTHOR]

The article presents a case study of a two-year-old male child who was admitted to the hospital with a parasitic rachipagus twin which was attached to his dorsolumbar region. Topics discussed include description of the twin which comprised of two rudimentary limbs and an anal dimple and details regarding the two theories of embryogenesis which are the fission and fusion theories.

A letter to the editor is presented regarding the case study of a two-month-old conjoined twins with thoracoabdominopagus who were presented for hepatobilliary scintigraphy by 99mTc-mebrofenin.