SUCCESSFUL SEPARATION OF ISCHIOPAGUS TRIPUS TWINS FOLLOWING ABDOMINAL WALL EXPANSION BY PNEUMOPERITONEUM

Abstract

Ischiopagus tripus conjoined twins are rare. Only 13 reports describing the separation of this twins have been seen in the world literature so far. On the separation operation, repair of the large abdominal wall defect following separation often poses a more complex problem rather than separation itself. In this paper, a case of ischiopagus tripus conjoined twins is reported with particular emphasis on the primary closure of the large abdominal wall defect following separation. We tried the subcutaneous placement of tissue expanders, and pneumoperitoneum prior to separation. Tissue expanders had to be removed because of infection. Pneumoperitoneum, without any complication, was quite effective to obtain abdominal wall expansion. With the use of a vascularized pedicle graft made from the fused third limb, primary abdominal closure of the large abdominal wall defect was achieved without tension in each twin. No wound dehiscence or necrosis of the pedicle graft was seen in the postoperative course.