The separation of pygopagus conjoined twins with fused spinal cords and imperforate anus

Each set of conjoined twins has specific anatomic features dictating unique challenges to separation. Overcoming these challenges requires creative solutions that necessitate interdisciplinary collaboration. We present a unique case of pygopagus conjoined twins with fused spinal cords, imperforate anus without fistula, and a single anal sphincter complex. Separation included the use of novel applications of 3D printing and neurophysiologic monitoring. The 3D print helped to clarify the complex anatomy and facilitate communication during planning sessions. The neurophysiologic monitoring helped to distinguish a plane of separation for the spinal cords as well as the shared anal sphincter. Implementing these technologies and thus successfully separating these twins safely required a multidisciplinary team that extended beyond clinical specialties.