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Epigastric heteropagus conjoined twins: two case studies and associated DNA analysis.

Xie JT, Zhou L, Yang ZL, Sun HY - Clinics (Sao Paulo) (2012)

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University, The First Affiliated Hospital of Guangzhou, Department of Pediatric Surgery, People's Republic of China.

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Heteropagus conjoined twins are asymmetrically conjoined twins, in which one twin is nearly anatomically normal (autosite), and the other twin remains anatomically incomplete (parasite) but physically attached to the autosite... Epigastric heteropagus conjoined twins (EHTs), referring to a parasitic twin who is attached to the epigastrium of the autosite, are extremely rare... The parasite possessed two upper limbs, two lower limbs, a pelvis, and a well-developed scrotum and penis, which produced urine discharge (Figure 1-A)... However, the limbs of the parasite had neither active movement nor response to tactile stimulus... The parasitic twin was attached to the epigastrium of the autosite, in whom an infected omphalocele and a large ventral hernia were found (Figure 2-A)... Omphaloceles were present below the cartilage by which the twins were attached in both of our cases... Many studies have considered omphaloceles to be commonly associated anomalies in EHTs... Tongsin et al. reported four cases of EHTs, three of which were associated with omphaloceles... The large hernia rendered the repair of the abdominal wall particularly difficult because the simultaneous repair of the hernia and removal of the parasitic twin would have significantly increased the intra-abdominal pressure and could have caused ICS... Therefore, we delayed the hernia repair until the twentieth month after birth... VYPRO II mesh (Ethicon) was used to successfully repair the hernia... Despite the unusual clinical appearance and pathogenesis associated with EHTs, EHT patients usually have a good prognosis following a successful separation surgery... However, early diagnosis, diligent prenatal management, and selection of the proper route of delivery are critical to the success in treating EHT patients.

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(A) The parasitic twin in case 1 had a fully developed pelvis, two pairs of limbs, and a well-developed penis, which produced urine discharge. (B) The livers of the parasite and autosite were physically attached in case 1. (C) The parasitic twin in case 1 contained a pair of well-developed kidneys. (D) The autosite in case 1 during the twelfth month after the operation to remove the parasitic twin.
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f1-cln_67p527: (A) The parasitic twin in case 1 had a fully developed pelvis, two pairs of limbs, and a well-developed penis, which produced urine discharge. (B) The livers of the parasite and autosite were physically attached in case 1. (C) The parasitic twin in case 1 contained a pair of well-developed kidneys. (D) The autosite in case 1 during the twelfth month after the operation to remove the parasitic twin.

Mentions: Case 1: The first patient was a 1-day-old, full-term normal delivery (FTND) male. The parasite was attached to the epigastrium of the autosite. The parasite possessed two upper limbs, two lower limbs, a pelvis, and a well-developed scrotum and penis, which produced urine discharge (Figure 1-A). However, the limbs of the parasite had neither active movement nor response to tactile stimulus. Surgery to separate the twins was performed during the third month after birth. The parasitic twin was connected to the sternum of the autosite by a tract of cartilage. Furthermore, the liver of the parasite was connected to the liver of the autosite such that the extrahepatic bile duct system was absent (Figure 1-B). The main vascular pedicle of the parasite originated from the falciform ligament of the autosite. The pelvis of the parasite contained two functioning kidneys (Figure 1-C), a urinary bladder, and a small intestine but lacked a large intestine and anus. The small intestine of the parasite displayed proximal atresia and opened distal to the urethra. Skeletal muscle was absent in the limbs of the parasite. On the fourteenth day after surgery to remove the parasitic twin, the autosite was discharged from the hospital without complications and was followed up for 52 months. Figure 1-D shows a representative image of the autosite in case 1 at 12 months after the operation.


Epigastric heteropagus conjoined twins: two case studies and associated DNA analysis.

Xie JT, Zhou L, Yang ZL, Sun HY - Clinics (Sao Paulo) (2012)

(A) The parasitic twin in case 1 had a fully developed pelvis, two pairs of limbs, and a well-developed penis, which produced urine discharge. (B) The livers of the parasite and autosite were physically attached in case 1. (C) The parasitic twin in case 1 contained a pair of well-developed kidneys. (D) The autosite in case 1 during the twelfth month after the operation to remove the parasitic twin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351264&req=5

f1-cln_67p527: (A) The parasitic twin in case 1 had a fully developed pelvis, two pairs of limbs, and a well-developed penis, which produced urine discharge. (B) The livers of the parasite and autosite were physically attached in case 1. (C) The parasitic twin in case 1 contained a pair of well-developed kidneys. (D) The autosite in case 1 during the twelfth month after the operation to remove the parasitic twin.
Mentions: Case 1: The first patient was a 1-day-old, full-term normal delivery (FTND) male. The parasite was attached to the epigastrium of the autosite. The parasite possessed two upper limbs, two lower limbs, a pelvis, and a well-developed scrotum and penis, which produced urine discharge (Figure 1-A). However, the limbs of the parasite had neither active movement nor response to tactile stimulus. Surgery to separate the twins was performed during the third month after birth. The parasitic twin was connected to the sternum of the autosite by a tract of cartilage. Furthermore, the liver of the parasite was connected to the liver of the autosite such that the extrahepatic bile duct system was absent (Figure 1-B). The main vascular pedicle of the parasite originated from the falciform ligament of the autosite. The pelvis of the parasite contained two functioning kidneys (Figure 1-C), a urinary bladder, and a small intestine but lacked a large intestine and anus. The small intestine of the parasite displayed proximal atresia and opened distal to the urethra. Skeletal muscle was absent in the limbs of the parasite. On the fourteenth day after surgery to remove the parasitic twin, the autosite was discharged from the hospital without complications and was followed up for 52 months. Figure 1-D shows a representative image of the autosite in case 1 at 12 months after the operation.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University, The First Affiliated Hospital of Guangzhou, Department of Pediatric Surgery, People's Republic of China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Heteropagus conjoined twins are asymmetrically conjoined twins, in which one twin is nearly anatomically normal (autosite), and the other twin remains anatomically incomplete (parasite) but physically attached to the autosite... Epigastric heteropagus conjoined twins (EHTs), referring to a parasitic twin who is attached to the epigastrium of the autosite, are extremely rare... The parasite possessed two upper limbs, two lower limbs, a pelvis, and a well-developed scrotum and penis, which produced urine discharge (Figure 1-A)... However, the limbs of the parasite had neither active movement nor response to tactile stimulus... The parasitic twin was attached to the epigastrium of the autosite, in whom an infected omphalocele and a large ventral hernia were found (Figure 2-A)... Omphaloceles were present below the cartilage by which the twins were attached in both of our cases... Many studies have considered omphaloceles to be commonly associated anomalies in EHTs... Tongsin et al. reported four cases of EHTs, three of which were associated with omphaloceles... The large hernia rendered the repair of the abdominal wall particularly difficult because the simultaneous repair of the hernia and removal of the parasitic twin would have significantly increased the intra-abdominal pressure and could have caused ICS... Therefore, we delayed the hernia repair until the twentieth month after birth... VYPRO II mesh (Ethicon) was used to successfully repair the hernia... Despite the unusual clinical appearance and pathogenesis associated with EHTs, EHT patients usually have a good prognosis following a successful separation surgery... However, early diagnosis, diligent prenatal management, and selection of the proper route of delivery are critical to the success in treating EHT patients.

Show MeSH