Successful management of a parasitic ischiopagus conjoined twins in a low-income setting

Abstract

Ischiopagus parasites are fetal defects attached to a relatively normal twin by pelvis. This is the first reported case of parasitic ischiopagus twins without prenatal diagnosis successfully managed in Mozambique. A multidisciplinary team was involved in the supernumerary limbs excision. After 7 months, the infant has a normal development.

Keywords: Conjoined twins; developing country; ischiopagus; parasitic twins; surgical separation.

Figure 1

Clinical presentation of the twins when arrived at CHB (presurgical separation).

Figure 2

(A) Inferior limb X‐ray: four femurs, four tibias and four fibulas, one medial pair, and one distal pair each. Medial femurs were articulated with autoside's hip to its ischial part. (B) Retrograde urethrocystography: two kidneys with hydronephrosis, two ureters, anatomically normal bladder, right lateralized urethra. (C and D) Barium abdominal X‐ray: normal barium filling of the gastrointestinal tube without duplication nor dilatation or stenosis of GI tube. Right lateralization of perforated anus was evident.

Figure 3

Postsurgical specimen.

Figure 4

Clinical presentation at 7‐month follow‐up: She presents with a normal neurologic development: She is able to set down and to crawl. Anus and urogenital areas are lateralized to the right without any urinary or fecal incontinence.