Epigastric heteropagus and omphalocele : Case report
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Conjoined twins can be symmetrical or asymmetrical (heteropagus). Heteropagus twins consist of the anatomically normal autosite and a parasitic twin that is incompletely formed.

This case report is of a male infant with normal spontaneous vaginal delivery, mother was 38 years old. She had been submitted to ultrasonography, and the malformation had not been identified. The child had an epigastric heteropagus twin. The parasite had two lower limbs and male genitalia with developed phallus and scrotum but absent testis and absent anus. The parasite was passing urine. The limbs did not move or respond to external stimulus. An omphalocele was present just below the attachment of the parasitic twin and the parasitic bowel was slightly prolapsing through it.

Non-obstructive hypertrophic cardiomyopathy, ejection fraction (EF) 82%

~Contrast enhanced computed tomography (CT):
No obvious anomalies in the autosite viscera. No clear vascular or visceral contact between the twins. The parasite consists of pelvic and two femur bones with cystic formation may represent a bladder. A single pelvic kidney is suspected with some intestinal loops in the pelvis.

~Surgical laparotomy:
Circular incision was performed of the skin and subcutaneous tissue after taking sufficient skin from the parasite to ensure tension-free closure of the wound following separation. After that ligation was carried out of the parasitic urachus and mobilization its bladder. The pelvis of the heteropagus contained a bladder filled with urine with no kidney or ureter. There was 25 cm of bowel that open on the sac of the omphalocele with a slightly prolapse without any connection to the autosite’s gut. Resection was performed of the omphalocele sac. The blood supply to the parasite is derived from the falciform ligament, separating the parasitic partition. The rest of autosite viscera was normal.

This neonate withstood early surgery of epigastric heteropagus (EH) with omphalocele well, started oral feeding on the third day with good nutritional tolerance. Seven days after the surgery, there was dehiscence after wound infection. He was intubated and received parenteral nutrition. Then he acquired pneumonia. On the ninth day, he developed supraventricular tachycardia. Death occurred 40 days after the surgery because of respiratory distress and cardiac failure.

Source: https://academic.oup.com/jscr/article/2020/10/rjaa437/5939569