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Epigastric Heteropagus Parasitic twins: A Report of three cases (Abstract)

Iftikhar A Jan, Anwar-ul Haq, Ahmad Sharif, Saifullah Khan, Obaidullah Khan

The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan



Conjoined twins remained an enthusiastic and challenging issue for the treating surgeons. In parasitic twining one baby is fully formed (Autosite) whereas the other baby is incomplete (parasite) and is dependent upon the autosite for its nutrition. Management of babies with parasitic twining may look easy but the autosite usually has high incidence of associated cardiac anomalies and it may alter the outcome of surgery in these babies. We reviewed three pairs of parasitic epigastric heteropagus twins (EHT). First pair of twins had transpositioning of great vessels along with VSD and ASD. Parasite had fully formed pelvis and lower limbs but the upper limbs were partially formed with rudimentary spine from where it was attached to the autosite in the epigastrium. Babies had successful separation of the parasite but died after 8 months due to cardiac complications. Second pair of EHT had very similar appearance and had a soft systolic murmur suggesting congenital cardiac anomalies. Baby was taken abroad by volunteers and ultimate fate is not known. Third pair of twin was brought in sepsis and died within two days before full evaluation and any surgical intervention. Early referral and availability of pediatric cardiac services may improve ultimate outcome in many such babies.

Key words: conjoined, parasitic, heteropagus, twins.


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