Onfalopagus parasitic fusioned twin: A case report

INTRODUCTION AND IMPORTANCE

The parasitic fetus is a kind of siamese twin, in which one of the twins is reabsorbed and some parts of the body can remain attached to the other twin. It is a very rare event, with a birth incidence that varies from 0.05 to 1.47 cases per 100,000.

CASE PRESENTATION

This paper reports the case of a parasitic twin diagnosed at 34 weeks of gestational age. Preoperative ultrasonography was performed and the absence of communication between vital organs and the parasite was observed, and surgery was scheduled at 10 days of life. A multidisciplinary team performed the surgical procedure and the child was discharged from the intensive care unit after 3 months.

CLINICAL DISCUSSION

After diagnosis and birth, it is essential to investigate the anomalies found for future surgical programming, and cases of twins who do not share vital organs, for example, heart or brain, have higher survival rates. The treatment is surgical and the objective of the surgery must be resection of the parasite.

CONCLUSION

The diagnosis still in the gestational period is essential to plan the best mode of delivery and neonatal care, as well as define the surgical schedule. The hospital must be tertiary and the presence of a multidisciplinary team is necessary to perform the surgery in order to present the highest success rates.

Heteropagus twins: six cases with systematic review and embryological insights

PURPOSE

Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described.

METHODS

Six cases of HT managed at two tertiary care teaching hospitals over the last 26 years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed.

RESULTS

Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases.

CONCLUSION

Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance.

LEVEL OF EVIDENCE

IV.

Conjoined twins: A report of four cases

•

Conjoined twins are a subset of monozygotic twin gestation.

•

They are classified according to the most prominent site of conjunction.

•

Surgical separation of conjoined twins is extremely challenging and high risk.

•

Our reported omphalopagus had no associated anomalies.

•

The presence of associated malformations is unrelated to the site of union.

Background

Conjoined twin is a rarely seen congenital anomaly associated with significant morbidity and mortality. The most common types of conjoined twins are thoracopagus. Conjoined twins are either symmetrical twins or asymmetrical or heteropagus. This report records the successful separation of 2 cases of asymmetrical twins and one symmetrical twin with fused livers and diaphragm and communicating peritoneal cavities.

Patients and methods

This study amended and strictly followed the ethical guidelines of the Helsinki declaration, our study included 4 case reports on conjoined twins (CT), 2 male and three female patients; 3 of them were parasitic and one was conjoined. We operated upon 2 parasitics and one conjoined. The 1st case died preoperatively.

Results

Four living children is our result.

Conclusion

As connections between the bowel and bone of the parasite and the respective organs in the autosite are often absent, the parasite could be excised easily without any effect on the autosite. We recommend the separation of the parasite and the autosite as early as possible. In many cases, surgery results in the death of one or both of the conjoined twins, particularly if they are joined at the head or share a vital organ. Our separated twins are yet the youngest living separated twins.

Trial registration

ClinicalTrials.gov Identifier: NCT03388684

First report of the occurrence and different types of conjoined twins in common whitefish Coregonus maraena larvae originating from the Baltic Sea

This paper describes for the first time various forms of conjoined twins in the common whitefish Coregonus maraena originating from the brackish waters of the Baltic Sea. The occurrence of conjoined twins was observed during the hatching of whitefish under controlled conditions. Two types of twins were identified: symmetric (parapagus) and asymmetric (parasitic form). The percentage of conjoined twins among the whitefish did not exceed 0.01% of the hatched larvae. The forms of twins observed in this study were similar to conjoined twins occurring among humans. One main type, parapagus, was identified in the group of symmetric twins with 3 subtypes: diprosopus parapagus, dicephalic parapagus and dithoracic parapagus. In its parasitic form, the parasitic twin occurred as a 'cyclops' or just as an eye growing out of the other twin's head. We conclude that fish, as well as their fertilised eggs, can be used as a model system to observe how such twins are joined in humans because of the similarity with conjoined twins occurring in humans. Because of internal fertilisation in fish, as well as the size and transparency of egg cells in these animals, it is possible to observe the process of fertilisation, cell division and formation of an embryo and subsequently of twins, as a model for humans.