Omphalopagus conjoined twins separation during coronavirus disease-19 pandemic era: A case report

Abstract

Introduction and importance Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. Case presentation Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. Clinical discussion Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. Conclusion The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.

Pediatric Plastic Surgery in the COVID-19 Era

“…Two cases of this during the pandemic were described in the literature. 48,49 In the case of thoraco-omphalopagus female twins, baby 1 tested positive for COVID-19. 48 Once she stabilized and tested negative for COVID-19, the separation was performed by a multidisciplinary surgical team.…”

“…Microsurgery in the pediatric population is also involved in the closure of large defects, for example, as necessary in the separation of conjoined twins. Two cases of this during the pandemic were described in the literature 48,49 . In the case of thoraco-omphalopagus female twins, baby 1 tested positive for COVID-19 48 .…”

“…Baby B received a bilateral keystone design perforator island flap from the lateral side of the defect. The remaining defect on baby B's abdominal area was closed using a lower abdominal flap 49 . The teams both highlight the importance of ensuring safety of their patients by minimizing transmission of COVID-19 with strict screening protocols, minimizing number of surgical team members, personnel protective equipment use, and aiming for a short surgery duration while aiming for the best possible outcome 48,49 …”