Epigastric heteropagus and omphalocele

We report a case of epigastric heteropagus twins with omphalocele. The parasite had two lower limbs, genitalia with developed phallus and scrotum but absent testis and absent anus. An omphalocele was present just below the attachment of the parasitic twin. No kidney or ureter but only a bladder filled with urine seen during exploration. The parasite bowel was attached to an omphalocele sac prolapsing through it and there was connection to the autosite liver, which forms the main source of its blood supply. Surgery was performed in the neonatal period (Day 12 after birth) for both excision of epigastric heteropagus and omphalocele repair.

Parasitic twin with major cardiac defect: a case report

Parasitic twins are an extremely rare form of asymmetrical conjoined monochorial monoamniotic twins where one of them has a mostly intact body that is able to survive and which is referred to as ‘autosite’, while the counterpart, referred to as ‘parasite’, is only rudimentarily developed being physically attached to and nourished by the other twin. Our case is a baby boy with Single Ventricle Heart defect with a thoraco-abdominal mass (epigastric heteropagus twin) attached to the anterior abdominal wall near the umbilicus with minimal visceral sharing. The twins had two external genitalia both in host and parasite micturating separately. After high risk surgery the parasite could be separated completely from the host and postoperative recovery was uneventful.

Prenatal diagnosis of a “living” oropharyngeal fetus in fetu: a case report

Backgroud Fetus in fetu (FIF) is a rare malformation in which a parasitic twin within its more mature twin. Most of the FIF locate in the retroperitoneum and are acardiac and anencephalic. Case presentation Here, we describe a unique case of oropharyngeal fetus in fetu with a rudimentary two-chambered heart detected by prenatal ultrasonography. The parents terminated this pregnancy after counseling. Macroscopic examination found a solid mass between the oral and fetal chest, with a rudimentary two-chambered heart at the lowest part of the mass. Microscopic findings showed amniotic membrane, skin, cartilage, gastrointestinal and neural tissue. Conclusions Prenatal ultrasound can identify rudimentary organs suspecting FIF from early pregnancy. Detection of fetal heart beat facilitates differential diagnosis with teratomas, providing essential information for parental consulting and management.

Heteropagus Twins with Hepatobiliary and Gastrointestinal Connectedness and Complex Cardiac Malformation in Autosite

Introduction: Heteropagus twins are a set of conjoined twins with one being grossly abnormal, the ‘parasite’, and the other being relatively normal, the ‘autosite’. Case Report: A pair of heteropagus twins were initially identified on prenatal ultrasound and subsequently confirmed using prenatal MRI at 25 weeks gestational age. Prenatal imaging identified supernumerary limbs, accessory small bowel loops in the parasitic twin, a hypoplastic left heart in the right hemithorax of the autosite, and a shared liver and bowel between the two. Delivery occurred at 38 + 5 weeks gestation via C-section with an APGAR score of 9/9 for the autosite at both 1 and 5 minutes. MRI confirmed an interconnected autosite-parasite liver that was herniating into the left hemithorax as well as continuous autosite-parasite bowel loops. The patient underwent surgical management including resection of the parasitic twin and repair of the congenital heart defect and is now thriving. Discussion: Heteropagus twins include a spectrum of clinical entities from nonconjoined twins to intact conjoined twins. The predominant theory regarding etiology is an incomplete cleavage of a monozygotic embryo at approximately 2 weeks gestation. Following differentiation, ischemia-induced atrophy leads to the embryonic death of the parasite and hemodynamic changes in the autosite to support parasite tissues. The use of antenatal and postnatal imaging is crucial in establishing the diagnosis, management plan, and longterm prognosis secondary to the congenital cardiac malformations and degree of interconnectedness. Conclusion: This is the first reported case of heteropagus twins with co-existing hepatobiliary and gastrointestinal continuity.

A rare case of craniopagus parasiticus delivered vaginally at a district hospital

Craniopagus Parasiticus is a very rare type of parasitic twinning. It has an incidence of only 4-6/10,00,000 births. Most of the babies with Craniopagus Parasiticus are still born with only few cases which survived after postpartum surgical separation. In Craniopagus Parasiticus the head of one of the twins is parasitic and protrudes from the head of the normal twin with an undeveloped or underdeveloped body. The skulls of the twins are fused but the body of one of the twins is not developed. The developed twin is known as the auto site while the undeveloped twin is the parasite. Age of the mother or certain nutritional factors have been implicated in the etiology of this type of twinning. This is a rare case report of a female baby with a parasitic craniopagus delivered vaginally at this district hospital. The patient was a fourth gravida 28 year old. There was antenatal polyhydramnios. The patient delivered preterm a still born female baby with a parasitic co-twin. In this case the heads of the twins were fused in temporal and parietal areas while the body of the parasitic twin was completely undeveloped. It was a morphologically female baby with rudimentary labia. The causes of Craniopagus Parasiticus are still not known. Scientists and researchers are continuing work to determine these and also to improve the prognosis and chances of post-surgical survival of these twins. Till present day however there have been only limited number of studies on Craniopagus Parasiticus owing to the rarity of the cases.

Parasitic rachipagus conjoined twin: case report

A parasitic twin represents a rare developmental anomaly in which an asymmetrical, nonviable conjoined twin is attached to the host body at the time of birth. Rachipagus is among the rarest of conjoined twin subtypes and typically features a parasitic twin mass attached at the spine. Herein, the authors review the literature and describe the case of a 9-month-old girl presenting with a rachipagus parasitic twin consisting of a fully developed set of lower extremities originating from the midline upper back. After a complete workup to delineate parasite and autosite anatomy, the parasitic twin mass was successfully excised by a multidisciplinary team of surgeons, and the resulting defect was closed in a single stage.