Surgical Separation of Pygopagus Conjoined twins at Holy Family Hospital Rawalpindi; a Neurological Surgery Perspective and Outcomes: a Case Report

Abstract

Objective: Objective: Conjoined twins are considered to be the result of aberrant embryogenesis with incomplete embryonic separation. Estimated incidence of Conjoined twins is 1:50,000 pregnancies, and 1:200,000 live births, in new-borns with a female predominance of 3:1. Conjoined twins are classified into different subtypes according to the site of fusion: Thoracopagus, Omphalopagus, Pygopagus, Ischiopagus, and craniopagus. Even in conjoined twins, Pygopagus has an incidence of 6-19%; subsequently, not many cases have been reported worldwide. Case: This case report is about 6 months old female Pygopagus conjoined twins who fused at the lumbosacral level with a shared spinal canal. They were successfully separated in Pakistan with great success and had no neurological deficits on consequent follow-ups. An adequate build-up of physiological parameters until twins are old enough to undergo separation with multi-disciplinary management is the cornerstone of the successful management and separation of Pygopagus twins which is only possible in planned elective settings. Whereas emergency separation in the background of concomitant sepsis and sharing of vital organs carries high mortality and raises valid ethical questions regarding which life to prioritize saving and what organs to give to either viable child in case of shared CVS, GIT, and genitourinary systems.