Delayed presentation of a heteropagus (parasitic) twin

Abstract

Conjoined twins are rare, but well-described, anomalies. The heteropagus (parasitic) variant, in which there is a fully functioning autosite and a partially formed parasite, is even more rare. Typically, patients with this condition are discovered and treated as neonates or infants. We present an unusual case of an ischiopagus patient presenting at 17 years of age, which appears to be the oldest recorded presentation for surgery of a heteropagus twin in the English literature. The patient had two additional developed lower extremities along with two additional rudimentary upper extremities. The challenges and lessons learned from this rare and complex surgery are discussed.

Successful management of a parasitic ischiopagus conjoined twins in a low‐income setting

“…This is the first case of a newborn with ischiopagus PTC managed in Mozambique. A previous case was reported in Ethiopia in a 17‐year‐old female . In that case, on the one hand, the older age surely led to more complex surgery, due to diminished potential of remodeling, while on the other hand, the postoperative phase surely benefitted from better recovery capacity.…”

“…Finally, in typical ischiopagus PCTs, the parasite usually presents with some internal viscera and often shares genitourinary organs or colon with the autoside . Moreover, it is not infrequent to find parasitic external genitalia or autoside's malformations such as defects of abdomen wall or neural tube defects (Table ).…”

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“…Physicians from Loma Linda, California and Addis Ababa, Ethiopia presented a case study involving surgical treatment of the world's oldest heteropagus conjoined twin (Gokcen & Wamisho, 2015). Heteropagus twins are variants of conjoined twins, in that there is a functioning autosite (the larger of two conjoined twins and able to function independently) and a parasitic twin that is nourished by the autosite.…”