Unbalanced cross circulation in conjoined twins

Abstract

Case 1. This is a pair of ischiopagus tripus conjoined twins. They lvere fused face-to-face from qphoid process to the pel\is and were lying obliquely at approximately 110 degrees to one another. During the growing stage before separation, twin X became significantly malnourished in spite of having a good appetite. On the contrary, twin B looked healthy and well nourished although he ate \-cry little. Selecti\-e angiogram from the aorta of twin A showed a communicating inferior mesenteric artery (IhLA) with active blood flowing from twin .I to twin B (Fig. 1). No portal system could be seen by this aortogram in twin -4; although the portal system of twin B could be identified easily at the late phase. The systolic blood pressure was aromid 40 to 50 mm Hg in twin -I3 lvhereas it was between 68 and SO mm Hg in twin B. Urine amount was much less in twin A than in twin B. Unbalanced cross circulation with much blood flow from twin -1 to twin B was highly suspected. The separation operation was performed successfully when the twins were 2 years 2 months old and weighed 17.5 kg. A 4 mm IM.- and several 5 to 8 mm pelvic venous communications were identified and divided during the operation. ,titer the separation, blood pressures in both babies became similar, ranging between 70 and 80 mm Hg. Their urine amounts lvere also similar. Their body weights became the same 6 months later. Case 2. A pair of xiphoomphalopagus conjoined n\ins were delivered with a combined body weight of 3984 gm. The!; were joined face to face from rhe lower sternum down to the infraumbilical area. Tachypnea and tachycardia occurred in twin B from the third day after deliye?. Blood pressure was low in twin .A and high in twin B with an apparent discrimination, even though the same amountS of milk and intravenous fluid