Heteropagus conjoined twins are asymmetric conjoined twins. The tissues of the severely defective twin are dependent on the cardiovascular system of the other twin (autosite). Parasitic conjoined twins are an extremely rare condition that represents 1% - 2% of all conjoined twins. When parasite’s attached to host epigastrium, anomaly is called epigastric heteropagus twins (EHT) and it is exceedingly rare.A cephalic epigastric heteropagus case and its surgical issues ia reported here.
A thirteen day old full term male baby was brought to the neonatal emergency unit with an attached disformed twin. A parasitic twin with an hydrocephalic head and a rudimentary trunk with limb buds and a rudimentary lower limb was attached to the epigastrium. The parasitic hydrocephalic head contained a dysmorphic face with anophtalmia and dysgenesic ears. There was a supra-umbilical eventration without omphalocele. No heart activity was found in the parasit.
Separation was performed at day 26 with parietal refection, leaving eventration for a subsequent procedure. The parasite was 960g and exploration showed one small bowel without any other organ.
Postoperative care was conducted at the neonatal intensive care unit. The baby was fed the same day. The course was complicated by a skin infection treated by local care.
The patient was discharged from the hospital on day 53 weighing 2.45 Kg after skin healing and satisfactory weight gain. Eventration care was scheduled to about 2 years.
An extremely rare abnormality which is usually diagnosed antenatal. In this case the diagnosis was made upon birth. The separation succeeded with limited explorations and technical platforms.
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