Epigastric Heteropagus Research Articles

An unusual case of monozygotic epigastric heteropagus twinning

Epigastric heteropagus refers to unequal and asymmetric conjoined twins in which the dependent component (parasite) is smaller and usually attached to the epigastrium of the dominant component (autosite). Epigastric heteropagus is a very rare type of conjoined twins. It is generally assumed that conjoined twins represent a form of monozygotic twinning, but there has been no confirmation of this monozygotic hypothesis. Epigastric heteropagus twins differ in several ways from symmetrical conjoined twins. These include male preponderance, and no major connection of vessels, bowels, or bones. These significant characteristics suggest to the authors that the fusion of two fertilized ova and the atrophy of one fetus resulted in this interesting malformation. However, a DNA study indicated monozygotic origin in their case. The possible pathogenesis was ischemic atrophy of the body structure of the monozygotic conjoined twins at an early gestational age.

Late presentation of epigastric heteropagus

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.