The First Case of Fetus in Fetu in Nicaragua: The Management Experience of the Pediatric Neurosurgery Team

Abstract

Fetus in fetu (FIF) is a rare congenital anomaly of asymmetric monozygotic twins, where the parasitic twin develops abnormally inside the body of the host twin. In most cases, it is incorporated into the sibling's abdomen, which frequently presents as a retroperitoneal mass. Currently, at least 200 cases have been reported worldwide, being this the first case in Nicaragua. We describe a case of a male newborn, born via cesarean section, with a history of multiple congenital malformations observed via ultrasound examination. At birth, a mass is observed on its dorsum that impresses a skull, but without the presence of bones, with three limbs, two upper and one lower, with an outline located transversely on the pelvic girdle and the presence of two male genitalia with agenesis of the testicles and an accessory kidney. A preoperative diagnosis of FIF and spinal dysraphism was made by computed tomography (CT) and magnetic resonance imaging (MRI). They shared a spinal cord and had the presence of an open spinal defect type meningocele with aberrant roots. After the diagnosis and discussion, the multidisciplinary team proceeded to surgery to perform the separation of the twin (FIF). The subsequent anatomopathological examination revealed that the fetus was anencephalic and had reliable FIF characteristics. The resection was performed followed by the closure of the 430 mL meningocele and complete separation of the spine and the parasitic twin. We present the first case of fetus in fetu in Nicaragua.

Keywords: fetus in fetu; meningocele; neural tube defect; parasitic twin; spina bifida.

Figure 1. A and B: A one-week-old newborn in good general condition with paraplegia (T12-L1) with a parasitic twin attached from the dorso-lumbosacral region, amorphous, that contains rudimentary traces of the hand, right finger and left finger outline, and two extremities. C and D: Simple tomographic images and 3D reconstruction where the amorphous parasite twin with a liquid cavity and part of the extremities adhered to the newborn with the organs, viscera, muscles, and bones of the latter with adequate biology and formation. D and E: Magnetic resonance images in T1 and T2 where it is observed that both share the same column, spinal defect of the posterior elements from L1 to L2 onward, compatible with spina bifida with nerve root involvement and with a lesion compatible with myelomeningocele with multiple septal agenesis of almost the entire sacrum with a discreet vestige.

Figure 2. A: Exposure of the cystic cavity of the meningocele. B and C: Disarticulation and muscular vestiges of the parasitic twin. D: Myocutaneous fascia flap and closure of the entire skin defect.