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Fernández JÁ, Marín GM, Tocuyo YE. Gemelo Heterópago. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los gemelos parásitos o heterópagos son aquellos unidos asimétricos con partes deformes del parásito que se unen en diferentes regiones del gemelo normal (autosite), del cual depende para su soporte nutricional y crecimiento. Presentamos el caso de un gemelo heterópago con las extremidades inferiores y rudimentos de las superiores del parásito unidas al periné y glúteo derecho del autosite. Aunque no compartían órganos pélvicos, la compresión extrínseca de estructuras óseas del parásito causaron estenosis del recto, lo que obligó a la corrección quirúrgica. Los estudios por imágenes permitieron planificar la cirugía, lo cual facilitó la separación exitosa y lograr la sobrevida del paciente con muy buena calidad de vida. A pesar de ser reportados desde épocas ancestrales, aún generan gran interés debido a la variabilidad en su presentación clínica y al desconocimiento en su etiopatogénesis.
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Recurrence of parasite in epigastric heteropagus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kesan K, Gupta A, Gupta RK, Kothari P, Ranjan R, Karkera P, Mudkhedkar K. Gluteal flap for omphalocele repair in a case of epigastric heteropagus: A novel approach for surgical management. Indian J Plast Surg 2013; 46:127-9. [PMID: 23960319 PMCID: PMC3745099 DOI: 10.4103/0970-0358.113731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epigastric heteropagus is an extremely rare congenital anomaly, in which there is asymmetrical conjoined twinning, with the parasitic twin attached to the epigastrium. A 2-day-old male, with epigastric heteropagus and omphalocele, was operated in our institution. After excision of the parasitic twin, omphalocele was covered with a gluteal skin flap available from the parasitic twin. Post-operative course was uneventful, except for infection along the edges of the skin flaps, which was managed conservatively. Only 44 cases of epigastric heteropagus twins have been reported previously in world literature. We present a novel surgical approach for the repair of the omphalocele in a case of epigastric heteropagus twins, probably the 45(th) case to be reported in the world literature.
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Affiliation(s)
- Krushnakumar Kesan
- Department of Pediatric Surgery, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
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Xie JT, Zhou L, Yang ZL, Sun HY. Epigastric heteropagus conjoined twins: two case studies and associated DNA analysis. Clinics (Sao Paulo) 2012; 67:527-9. [PMID: 22666802 PMCID: PMC3351264 DOI: 10.6061/clinics/2012(05)22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jun-tao Xie
- Sun Yat-sen University, The First Affiliated Hospital of Guangzhou, Department of Pediatric Surgery, People's Republic of China
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Ozkan-Ulu H, Yilmaz Y, Sari FN, Altug N, Uras N, Dilmen U. An unusual case of heteropagus: autosite with a complex cardiac malformation. Pediatr Neonatol 2011; 52:358-60. [PMID: 22192266 DOI: 10.1016/j.pedneo.2011.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 10/15/2022] Open
Abstract
Asymmetrical form of conjoined twinning (heteropagus) is an extremely rare event with an incidence of 1-2 million live births. The incomplete component of heteropagus, namely, parasite, usually consists of rudimentary organs. Therefore, the autosite component of heteropagus can be separated successfully. A wide spectrum of associated congenital cardiac malformations, which are usually minor, has been described in autosites. However, a single-ventricle heart anomaly in the autosite has been reported in a very few cases. We report an unusual case of heteropagus with a complex cardiac malformation. To the best of our knowledge, this is the third heteropagus case in the literature with a single-ventricle heart in the autosite.
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Affiliation(s)
- Hulya Ozkan-Ulu
- Division of Paediatric Surgery, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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Heteropagus (parasitic) twins: a review. J Pediatr Surg 2010; 45:2454-63. [PMID: 21129567 DOI: 10.1016/j.jpedsurg.2010.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/21/2022]
Abstract
Heteropagus, or "parasitic," twins are asymmetric conjoined twins in which the tissues of a severely defective twin (parasite) are dependent on the cardiovascular system of the other, largely intact twin (autosite) for survival. The estimated incidence of heteropagus twins is approximately 1 per 1 million live births. Isolated case reports comprise most of published work on this rare congenital anomaly. In the past, review articles have focused narrowly on one particular anatomical subtype of parasitic twin and/or on the anatomicopathology observed. Here, we present the epidemiology, proposed pathoembryogenic origins, anatomical abnormalities, management, and outcomes of the wide array of heteropagus twins described in the English language literature.
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Jain P, Borwankar SS, Parelkar S, Mishra P. Parasitic omphalopagus with cranioencephalic malformation and rudimentary cardio-pulmonary system. Indian J Pediatr 2010; 77:704-5. [PMID: 20454937 DOI: 10.1007/s12098-010-0071-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thoracopagus parasites in two sets of twins: evidence for the fusion theory. Pediatr Surg Int 2008; 24:1255-9. [PMID: 18810464 DOI: 10.1007/s00383-008-2248-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2008] [Indexed: 10/21/2022]
Abstract
We report two sets of parasitic twins attached in the thoracic region. Exomphalos major in the autosite was present in both cases. While in case 1, the autosite could be salvaged after easier dissection, in case 2, the autosite could not be salvaged due to the presence of the life-threatening anomalies. The presence of a right-angled communication between the gastrointestinal tracts of the autosite and the independent tactile responses of the parasite from that in the autosite supports the 'fusion theory' to explain the fusion of the embryos that could have led to this defect. The presence of the ano-rectal malformation and common bile duct dilatation exclusively in the parasite appears to be the result of the abnormalities in the endodermal-mesodermal interactions, probably due to the relative positioning of the parasite with respect to the autosite.
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Ozturk H, Otcu S, Ozturk H, Duran H. Umbilical heteropagous twinning: a case report. Fetal Pediatr Pathol 2007; 26:255-60. [PMID: 18363158 DOI: 10.1080/15513810701818411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heteropagous conjoined twins are rare and umbilical heteropagous conjoined twins are extremely rare. We present a case with umbilical heteropagous conjoined twins and discuss the diagnosis and management. The parasitic component of heteropagous can be separated and treated successfully in the majority of cases.
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Affiliation(s)
- Hayrettin Ozturk
- Medical School, Department of Pediatric Surgery, Abant Izzet Baysal University, Bolu, Turkey.
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Kanamori Y, Tomonaga T, Sugiyama M, Hashizume K, Goishi K, Haga N. Bizarre Presentation of Epigastric Heteropagus: Report of a Case. Surg Today 2006; 36:914-8. [PMID: 16998686 DOI: 10.1007/s00595-006-3275-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
We report an unusual case of epigastric heteropagus in a female neonate. The parasite had a single lung as well as a liver, stomach, intestine, pancreas, ovaries, a single kidney, and a bladder. These visceral organs were located in the abdominal and pelvic space of the autosite, and the pelvic bone and lower legs of the parasite were fused with the respective organs in the autosite. The infant underwent operations to remove the central leg and some of the intra-abdominal organs of the parasite, but she must still undergo further surgery to remove the genitourinary organs and pelvic bones of the parasite, and repair her very abducted and rotated right leg.
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Affiliation(s)
- Yutaka Kanamori
- Departments of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Tokyo 113-8655, Japan
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Abstract
Conjoined twins are rare, heteropagus conjoined twins are rarer, and epigastric heteropagus conjoined twins are rarer still. It refers to unequal and asymmetrical twinning in which the dependant component (parasite) is smaller and attached to the epigastrium of the dominant component (autosite). We report 3 cases of epigastric heteropagus conjoined twinning. A review of literature is presented along with a discussion of possible etiopathogenesis.
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Affiliation(s)
- Manish Bhansali
- Pediatric Surgery Unit, NSCB Medical College, Jabalpur (M.P.), 482003, India
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Abstract
The authors report a rare case of asymmetric conjoined twins in which the incomplete parasitic twin was attached to the lumbar area of the autosite. The parasitic twin had well-formed bony pelvis, both lower limbs, partial genitourinary, and gastrointestinal tracts. The parasitic twin was excised, and the exomphalos was repaired.
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Affiliation(s)
- J K Mahajan
- Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Petit T, Raynal P, Ravasse P, Herlicoviez M, Delmas P. Prenatal sonographic diagnosis of a twinning epigastric heteropagus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 17:534-535. [PMID: 11422980 DOI: 10.1046/j.1469-0705.2001.00417.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Epigastric heteropagus is a rare type of conjoined twinning which results from an ischemic atrophy of one fetus at an early stage of gestation. We present what we believe to be the first case diagnosed antenatally at 22 weeks' gestation. The pelvis and lower limbs of the ischemic fetus (the parasite) were attached to the epigastrium of the well-developed fetus (the autosite), which had a small omphalocele. Antenatal sonography provided an accurate diagnosis, enabling unnecessary abortion to be avoided.
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Affiliation(s)
- T Petit
- Department of Pediatric Surgery and Department of Obstetrics and Gynecology, Caen University Hospital, France.
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Ozcan C, Ergün O, Güçlü C, Tümüklü M, Alper H, Erdener A. An unusual case of epigastric heteropagus: parasite with a rudimentary heart. J Pediatr Surg 2000; 35:1523-5. [PMID: 11051169 DOI: 10.1053/jpsu.2000.16432] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parasitic or heterotopic conjoined twins are exceedingly rare, and these cases are referred to as "heteropagus" when there is a parasitic attachment in a nonduplicated fashion to any portion of the body. Epigastric heteropagus twinning refers to the attachment of the parasite to the epigastric region of the autosite. An unusual epigastric heteropagus case is presented with a rudimentary cardiopulmonary and also nearly complete gastrointestinal and genitourinary system of the parasite, and an organogenetic and vascular status of the previously reported cases are reviewed. The current case might be unique for the parasite having a cardiopulmonary development--although rudimentary--and this might be the reason that it has more complete organogenesis than the cases that have been presented previously in the literature.
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Affiliation(s)
- C Ozcan
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Otiang'a-Owiti GE, Oduor-Okelo D, Kamau GK, Makori N, Hendrickx AG. Morphology of a six-legged goat with duplication of the intestinal, lower urinary, and genital tracts. Anat Rec (Hoboken) 1997; 247:432-8. [PMID: 9066922 DOI: 10.1002/(sici)1097-0185(199703)247:3<432::aid-ar16>3.0.co;2-q] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND An adult female goat with rare malformations, which consisted of duplication of the intestinal, lower urinary, and genital tracts as well a pair of parasitic appendages, is presented. METHODS A complete dissection was performed on a moribund female goat (Capra hircus). RESULTS The animal had a normal body with a parasitic attachment located within the pelvic region. This attachment was represented by an ovoid, trunk-like, adipose mass that lacked internal organs or vertebrae but that had two fairly well-developed limbs with the normal components of hind limbs. There was duplication involving the external and internal genitalia, the urethra, the urinary bladder, and portions of the small intestine as well as the large bowel, including the anal openings. CONCLUSIONS An autosite with a duplication involving the hindgut and paramesonephric anlages was identified. These features were compatible with life in utero and postutero and emanated from incomplete twinning (heteropagus twins). A review of the literature also suggests that heteropagus twins are a very rare abnormality in both domestic animals and humans.
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Abstract
Epigastric heteropagus refers to unequal and asymmetric conjoined twins in which the dependent component (parasite) is smaller and usually attached to the epigastrium of the dominant component (autosite). Epigastric heteropagus is a very rare type of conjoined twins. It is generally assumed that conjoined twins represent a form of monozygotic twinning, but there has been no confirmation of this monozygotic hypothesis. Epigastric heteropagus twins differ in several ways from symmetrical conjoined twins. These include male preponderance, and no major connection of vessels, bowels, or bones. These significant characteristics suggest to the authors that the fusion of two fertilized ova and the atrophy of one fetus resulted in this interesting malformation. However, a DNA study indicated monozygotic origin in their case. The possible pathogenesis was ischemic atrophy of the body structure of the monozygotic conjoined twins at an early gestational age.
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Affiliation(s)
- E H Hwang
- Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea
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