Case Report: The Medical and Surgical Management of an Infant With Extreme Prematurity and Fetus-In-Fetu

Raphael C Sun,Lily S Cheng,Nahir Cortes-Santiago,Sundeep G Keswani,Pablo Lohmann,Pamela D Ketwaroo,Timothy C Lee,Rita H Shah,Alice King

doi:10.3389/fsurg.2022.856837

Abstract

Fetus-in-fetu (FIF) is a rare congenital anomaly where a parasitic twin is within the body of a host twin. FIF is reported to occur in 1:500,000 live births. Herein, we report the first case of the medical and surgical treatment of a FIF patient who was born with extreme prematurity at 25-weeks gestation. With the multi-disciplinary coordination of neonatology, surgery, and interventional radiology, the patient was able to achieve a window of medical stability 4 weeks after birth. A decision was made at that time to proceed with an intra-abdominal and perineal resection of the FIF. The FIF was successfully resected and the patient was able to recover from the operation, with eventual discharge from the NICU. In conclusion, extreme prematurity and FIF may be amenable to surgical resection and a multi-disciplinary approach is crucial to achieve the desired outcome.

Highlights

Fetus-in-fetu (FIF) is an extremely rare congenital anomaly that occurs in 1:500,000 births [1]
FIF is a rare congenital anomaly described as a malformed or parasitic twin enclosed within the body of a newborn or adult [3, 5–7]
The second hypothesis is that these masses are teratomas consisting of ectoderm, endoderm, mesoderm germinal layers [7]

Summary

INTRODUCTION

Fetus-in-fetu (FIF) is an extremely rare congenital anomaly that occurs in 1:500,000 births [1] It is described as a parasitic twin within the body of a host twin. Prenatal imaging included fetal MRI (Figure 1) and ultrasound demonstrating a host “outer” twin A and an intra-abdominal/pelvic “inner” parasitic twin B. Postnatal images confirmed mass effect by the parasitic twin, superiorly displacing the host twin diaphragm, preventing full lung expansion. In the immediate post-natal period, a pelvic / abdominal ultrasound was performed which revealed a large amount of fluid surrounding the retained fetus which appeared to displace the diaphragm superiorly. Disorganized fetal neural elements were present with only a rare focus of immature neuroepithelium This infant was discharged after 257 days in the hospital and required a tracheostomy for respiratory failure and a gastrostomy tube for enteral feeds. She was given a diagnosis of left hemiplegic cerebral palsy secondary to prematurity as the upper extremity preference would not be explained by potential damage to lower extremity neuromuscular

DISCUSSION

Findings

CONCLUSION

ETHICS STATEMENT