New techniques in the diagnosis and operative management of siamese twins

Abstract

New techniques of 2-D sonography and radionucleotide Disofenin scanning allowed noninvasive evaluation of thoracoomphalopagus Siamese twins and successful separation at four days of age. Twin girls joined at the lower sternum and upper abdomen and weighing 15 lbs, were transferred at five hours of age after caesarian-section delivery. Scout films revealed high intestinal obstruction in twin A. 2-D sonography showed separate and normal hearts with different rates and attached pericardial sacs. Labeled Disofenin given intravenously to twin A was excreted exclusively in her gallbladder and bile ducts; vice versa for twin B. Because operation was necessary to correct jejunal atresia in twin A, further growth and development was not an option and the parents agreed to total correction. Sternal and pericardial separation and division of common midline-liver was followed by primary diaphragmatic defect repair and Dacron-cloth fascial reconstruction to upper abdominal wall and complete soft-tissue and skin closure in a ten-hour operation. Segmental jejunal resection and anastomosis with gastrostomy was added in baby A. The new tests greatly simplified definition of the anatomical relationships and implemented rapid correction in these newborn conjoint twins.