A Surgical Separation of Pygopagus Conjoined twins at Holy Family Hospital Rawalpindi; a Neurological Surgery Perspective and Outcomes: a Case Report

Article Sidebar

Full Text (PDF)
Published: Jul 28, 2022
DOI: https://doi.org/10.36472/msd.v9i7.753
Keywords:
Pygopagus Conjoined twins paediatric surgery Neurosurgery

Main Article Content

Nadeem Akhtar
Rawalpindi Medical University, Dept. of Neurosurgery, Rawalpindi, Pakistan.
Yasir Shahzad
Rawalpindi Medical University, Dept. of Neurosurgery, Rawalpindi, Pakistan.
Mudassir Gondal
Paediatric Surgeon
Muhammad Motsim Shah
Rawalpindi Medical University, Dept. of Neurosurgery, Rawalpindi, Pakistan
Mudassir Abbass
Rawalpindi Medical University, Dept. of Neurosurgery, Rawalpindi, Pakistan.
Nehal Nadeem
Shifa International Hospital, Islamabad

Abstract

Objective: Objective: Conjoined twins are considered to be the result of aberrant embryogenesis with incomplete embryonic separation. Estimated incidence of Conjoined twins is 1:50,000 pregnancies, and 1:200,000 live births, in new-borns with a female predominance of 3:1.


Conjoined twins are classified into different subtypes according to the site of fusion: Thoracopagus, Omphalopagus, Pygopagus, Ischiopagus, and craniopagus. Even in conjoined twins, Pygopagus has an incidence of 6-19%; subsequently, not many cases have been reported worldwide.


Case: This case report is about 6 months old female Pygopagus conjoined twins who fused at the lumbosacral level with a shared spinal canal. They were successfully separated in Pakistan with great success and had no neurological deficits on consequent follow-ups. An adequate build-up of physiological parameters until twins are old enough to undergo separation with multi-disciplinary management is the cornerstone of the successful management and separation of Pygopagus twins which is only possible in planned elective settings. Whereas emergency separation in the background of concomitant sepsis and sharing of vital organs carries high mortality and raises valid ethical questions regarding which life to prioritize saving and what organs to give to either viable child in case of shared CVS, GIT, and genitourinary systems.

Downloads

Download data is not yet available.

Article Details

How to Cite
Akhtar, N. ., Shahzad, Y., Gondal, M. ., Shah, M. M., Abbass, M. ., & Nadeem, N. . (2022). A Surgical Separation of Pygopagus Conjoined twins at Holy Family Hospital Rawalpindi; a Neurological Surgery Perspective and Outcomes: a Case Report. Medical Science and Discovery, 9(7), 406–412. https://doi.org/10.36472/msd.v9i7.753
Issue
Vol. 9 No. 7 (2022): Medical Science and Discovery
Section
Case Reports
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

https://creativecommons.org/licenses/by-nc/4.0/

Received 2022-06-11
Accepted 2022-06-22
Published 2022-07-28

References

Spitz L. Conjoined twins. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2005 Sep;25(9):814-9.

Mutchinick OM, Luna‐Muñoz L, Amar E, Bakker MK, Clementi M, Cocchi G, da Graça Dutra M, Feldkamp ML, Landau D, Leoncini E, Li Z. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. InAmerican Journal of Medical Genetics Part C: Seminars in Medical Genetics 2011 Nov 15 (Vol. 157, No. 4, pp. 274-287). Hoboken: Wiley Subscription Services, Inc., A Wiley Company.

Boer LL, Schepens‐Franke AN, Oostra RJ. Two is a crowd: two is a crowd: on the enigmatic etiopathogenesis of conjoined twinning. Clinical Anatomy. 2019 Jul;32(wwwwwwwwwww5):722-41.

Mian A, Gabra NI, Sharma T, Topale N, Gielecki J, Tubbs RS, Loukas M. Conjoined twins: From conception to separation, a review. Clinical Anatomy. 2017 Apr;30(3):385-96.

Spitz L. Ethics in the management of conjoined twins. InSeminars in Pediatric Surgery 2015 Oct 1 (Vol. 24, No. 5, pp. 263-264). WB Saunders.

Winder M, Law A. Separation of pyopagus conjoined twins: a New Zealand neurosurgical experience. Journal of clinical neuroscience. 2006 Nov 1;13(9):968-75.

Jain P, Kundal AK, Sharma R, Khilnani P, Kumar P, Kumar P. Surgical separation of pygowwwwwwwwwwaaaawwwwwwwwwwwwwwwpagus twins: A case report. Journal of Pediatric Surgery Case Reports. 2014 Mar 1;2(3):119-22.

Hirokazu T, Takayuki I, Yoshinori H, Kazunari K, Akio A, Keiji K. Separation surgery of pygopagus asymmetrical conjoined twins sharing U-shaped spinal cord: case report and literature review. Child's Nervous System. 2013 Apr;29(4):699-706.

Punchak M, Mukhopadhyay S, Sachdev S, Hung YC, Peeters S, Rattani A, Dewan M, Johnson WD, Park KB. Neurosurgical care: availability and access in low-income and middle-income countries. World neurosurgery. 2018 Apr 1;112:e240-54.

Sun TS, Li SG, Zhang ZC, Li F, Guan K. Preoperative preparation and surgical separation of conjoined pygopagus twins. Chinese medical journal. 2010 Jul 5;123(13):1800-3.

Fusaro MV, Becker C, Pandya S, Mcbride W, Alizadeh K, Iannotti V, Zelkovic P, Barst S, Tobias ME, Mohan A, Freda J. International teleconsultation on conjoined twins leading to a successful separation: a case report. Journal of Telemedicine and Telecare. 2018 Aug;24(7):482-4.

Wood BC, Sher SR, Mitchell BJ, Oh AK, Rogers GF, Boyajian MJ. Conjoined twin separation: integration of three-dimensional modeling for optimization of surgical planning. Journal of Craniofacial Surgery. 2017 Jan 1;28(1):4-10.

Saguil E, Almonte J, Baltazar W, Acosta A, Caballes A, Catangui A, Villegas C. Conjoined twins in the Philippines: experience of a single institution. Pediatric surgery international. 2009 Sep;25(9):775-80.

Spitz L, Kiely EM. Experience in the management of conjoined twins. Journal of British Surgery. 2002 Sep;89(9):1188-92.