Late presentation of epigastric heteropagus

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Parasitic twins can attach to the host at a number of different locations. The most usual variant is caudal duplication (dipygus), where the parasite consists of additional pelvic and lower limb structures attached to the pelvis of the dominant twin. Less commonly, the rudimentary twin can attach to the anterior thorax, the thoracic spine, or the epigastrium, as in this case. A 13-year-old boy was successfully managed and represents the eighth case of epigastric heteropagus reported, and the oldest presentation of such a case.