Heteropagus Twins Research Articles

Epigastric heteropagus twinning with dextrocardia: a case report

Abstract Background Heteropagus twinning is a rare birth defect in 1 in million live births. Epigastric heteropagus is the most frequent type, in which a smaller dependent (parasite twin) is attached to the body of the host (autosite twin) to the thorax and umbilicus. Several congenital anomalies have been previously described in the host twin. We describe the first case of epigastric heteropagus twinning with dextrocardia and situs inversus in which a successful surgical separation is performed. Case presentation A 48-h-old female sex twins were presented to Bahawal Victoria Hospital. A careful anatomic study using contrast X-ray, magnetic resonance imaging, and echocardiogram showed epigastric heteropagus twinning and situs inversus in autosite twin. A successful surgical separation was performed, and the parasite twin was removed from the body of the autosite twin. Conclusions Antepartum screening detects congenital malformations; however, several pregnancies are unsupervised in underdeveloped countries. In the case of heteropagus twinning, careful surgical separation in the absence of complications leads to the favorable survival of the autosite twin.

Heteropagus twins: six cases with systematic review and embryological insights.

Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described. Six cases of HT managed at two tertiary care teaching hospitals over the last 26years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed. Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases. Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance. IV.

Anatomical features and challenges in separation and reconstruction of heteropagus twins

Heteropagus twins are an extremely rare condition and the term describes asymmetrical conjoined twins in which one twin (“autosite”) has a mostly intact body and the other twin (“parasite”) remains anatomically incomplete but is attached to and nourished by the other one. Autosites may show severe malformations themselves that are not associated with the twins’ fusion. Beyond the challenge of surgical separation further complex reconstructions may be necessary. In this case series we want to demonstrate that despite complex anatomic features, good functional (e.g. gastrointestinal, genitourinary and motoric) and aesthetic results can be achieved.

Parasitic twin with major cardiac defect: a case report

Parasitic twins are an extremely rare form of asymmetrical conjoined monochorial monoamniotic twins where one of them has a mostly intact body that is able to survive and which is referred to as ‘autosite’, while the counterpart, referred to as ‘parasite’, is only rudimentarily developed being physically attached to and nourished by the other twin. Our case is a baby boy with Single Ventricle Heart defect with a thoraco-abdominal mass (epigastric heteropagus twin) attached to the anterior abdominal wall near the umbilicus with minimal visceral sharing. The twins had two external genitalia both in host and parasite micturating separately. After high risk surgery the parasite could be separated completely from the host and postoperative recovery was uneventful.

Heteropagus Twins with Hepatobiliary and Gastrointestinal Connectedness and Complex Cardiac Malformation in Autosite

Introduction: Heteropagus twins are a set of conjoined twins with one being grossly abnormal, the ‘parasite’, and the other being relatively normal, the ‘autosite’.
 Case Report: A pair of heteropagus twins were initially identified on prenatal ultrasound and subsequently confirmed using prenatal MRI at 25 weeks gestational age. Prenatal imaging identified supernumerary limbs, accessory small bowel loops in the parasitic twin, a hypoplastic left heart in the right hemithorax of the autosite, and a shared liver and bowel between the two. Delivery occurred at 38 + 5 weeks gestation via C-section with an APGAR score of 9/9 for the autosite at both 1 and 5 minutes. MRI confirmed an interconnected autosite-parasite liver that was herniating into the left hemithorax as well as continuous autosite-parasite bowel loops. The patient underwent surgical management including resection of the parasitic twin and repair of the congenital heart defect and is now thriving.
 Discussion: Heteropagus twins include a spectrum of clinical entities from nonconjoined twins to intact conjoined twins. The predominant theory regarding etiology is an incomplete cleavage of a monozygotic embryo at approximately 2 weeks gestation. Following differentiation, ischemia-induced atrophy leads to the embryonic death of the parasite and hemodynamic changes in the autosite to support parasite tissues. The use of antenatal and postnatal imaging is crucial in establishing the diagnosis, management plan, and longterm prognosis secondary to the congenital cardiac malformations and degree of interconnectedness.
 Conclusion: This is the first reported case of heteropagus twins with co-existing hepatobiliary and gastrointestinal continuity.

Heteropagus (parasitic) twins

Abstract Heteropagus (parasitic) twin is a type of conjoined twinning in which a partially formed defective twin is attached to an otherwise normal twin. It is an extremely rare anomaly. In this paper, we describe five cases we encountered over the past 9 years. Except one, all presented early within a few days of birth. None of them shared an organ but two had bony/visceral connections. All surgeries were successful, and we only encountered wound complications. To the best of our knowledge this is the largest compilation of original cases in a parasitic twin report.

High prevalence of same-sex twins in patients with cloacal exstrophy: Support for embryological association with monozygotic twinning

PurposePrevious studies have hypothesized that cloacal exstrophy may be caused by errors early in embryological development related to monozygotic twinning. This study reports the prevalence of twins in a large cohort of patients with cloacal exstrophy. MethodsPatients with cloacal exstrophy treated 1974–2015 were reviewed for reports of multiple gestation or conjoined twinning. The genetic sex of the patient and their twin, and any mention of anomaly in the twin were recorded. Neither placental exam nor genetic testing results were available to definitively determine zygosity. ResultsOf 71 patients, 10 had a live born twin (14%), all of whom were of the same genetic sex as the affected patient. One additional patient's twin suffered intrauterine fetal demise, and another patient had a conjoined heteropagus twin. None of the twins were affected by exstrophy–epispadias complex. The rate of twin birth in this cohort was 4.4–7.7 higher than that reported by the Centers for Disease Control in the general population time period (P<0.001), with a striking preponderance of same-sex pairs. ConclusionsThe highly significant prevalence of same-sex twin pairs within this cohort supports the hypothesis that the embryogenesis of cloacal exstrophy may be related to errors in monozygotic twinning. Level of evidence2b

Twinsters the Movie: Reared Apart Twins in Real Time.

The 2015 documentary film Twinsters, tells the story of reared-apart MZ female twins, Samantha (Sam) Futerman and Anaïs Bordier. Born in South Korea, the twins were adopted separately as babies by couples living in the United States (Sam) and France (Anaïs). Their chance discovery of one another and their subsequent reunion and relationship are beautifully captured in the 2015 documentary film, Twinsters. Recent interviews with some of their family members are presented in Twin Research and Human Genetics for the first time. This is followed by brief reviews of recent twin research on a heteropagus twin, schizophrenia liability, epigenetics and homosexuality, and transgender-discordant twins. Finally, some newsworthy items are summarized, including the passing of reared-apart MZ twin Jack Yufe, an unusual twin father; identical twin models I; identical twin models II; and a pair of twin marines.

Situs inversus and dextrocardia in epigastric heteropagus twins: An uncommon entity explored!!

Epigastric heteropagus twin is a rare form of parasitic twins. Though heart defects may be found in 28% of these babies, an association with situs inversus and dextrocardia is extremely uncommon. We present a rare case of epigastric heteropagus twinning with dextrocardia and situs inversus.

An Epigastric Heteropagus Twin with Ruptured Giant Omphalocele

We present a case of heteropagus twins attached to the epigastric region. The neonate also had ruptured giant omphalocoele with most of gut and liver lying outside the abdominal cavity. Patient had uneventful surgery for separation of twins and repair of ruptured omphalocoele.

A rare case of heteropagus twin managed in his preadolescence at a rural tertiary level medical institute

Introduction: Parasitic or heteropagus twins are asymmetric conjoined twins in whom the severely defective twin (parasite) is depended on intact twin (autosite) for its vascular supply and growth. It is an extremely rare condition with estimated incidence of less than one per million live births. Case Report: A case of this rare entity which presented to us late in his preadolescence. The parasite had partially developed pelvis, lower limbs, nipples, hairs, nails and loops of the intestine. The case was successfully managed at a rural tertiary level institute. Conclusion: Parasitic or heteropagus twin is a extremely rare condition which require detailed evaluation to diagnose the degree of vascular, organ and soft tissue attachments before successful surgical excision.

Gluteal flap for omphalocele repair in a case of epigastric heteropagus: A novel approach for surgical management

Epigastric heteropagus is an extremely rare congenital anomaly, in which there is asymmetrical conjoined twinning, with the parasitic twin attached to the epigastrium. A 2-day-old male, with epigastric heteropagus and omphalocele, was operated in our institution. After excision of the parasitic twin, omphalocele was covered with a gluteal skin flap available from the parasitic twin. Post-operative course was uneventful, except for infection along the edges of the skin flaps, which was managed conservatively. Only 44 cases of epigastric heteropagus twins have been reported previously in world literature. We present a novel surgical approach for the repair of the omphalocele in a case of epigastric heteropagus twins, probably the 45th case to be reported in the world literature.

Een asymmetrisch dubbelmonster geassocieerd met andere congenitale afwijkingen bij een chihuahuapup

Een twee jaar oude chihuahua met duidelijk opgezet abdomen werd op 58 dagen dracht via een electieve keizersnede verlost van vijf normale en één duidelijk afwijkende pup. De misvormde pup was een asymmetrisch dubbelmonster waarbij de parasiet in het navelgebied met de autosiet verbonden was. De autosiet vertoonde aplasia cutis ter hoogte van het schedeldak, anasarca, lissencefalie, palatoschisis, sternale agenesie en eventeratio (gastroschisis/schistocoelia). De parasiet was slechts gedeeltelijk aangelegd en was ventraal ter hoogte van de thorax van de autosiet vastgehecht. De parasiet was samengesteld uit vier ledematen, terwijl kop en staart afwezig waren. Atresie van de anus en vulva werd opgemerkt. Inwendig werd slechts één enkele nier bij de parasiet aangetroffen. Voor zover de literatuur kon geraadpleegd worden, is deze casuïstiek slechts het derde uitvoerig beschreven geval van heteropagus bij de hond, waarbij de geassocieerde afwijkingen dit specifieke geval uniek maken. Een grondige literatuurstudie werd evenwel bemoeilijkt door het ontbreken van een uniforme nomenclatuur om een dergelijke vorm van dubbelmonsters te identificeren.

Antenatal Tanılı Epigastrik Heteropagus İkiz

Yapışık ikiz 50 000 ila 100 000 canlı doğumda bir görülen nadir bir anomalidir. Heteropagus ikiz (parazitik ikiz) ise, yapışık ikizlerin çok daha nadir olan özel bir formudur. Bu anomalide, ikiz eşlerinden biri tam gelişirken (konakçı ikiz) diğeri konakçıya bağlı bir şekilde asimetrik (parazitik ikiz) gelişir. Literatürde antenatal heteropagus tanısı olan yapışık ikiz sayısı son derece azdır. Oysa erken dönemde, doğru antenatal tanı aileye, özellikle hamileliğin sonlandırılması veya devamı konusunda ayrıntılı bilgi verilmesine yardımcı olur. Özellikle antenatal dönemde yapılan üç boyutlu sonografi tanıyı doğru koymamızı ve anomalinin ayrıntılarını daha iyi anlamamızı sağlar. Bu çalışmada, 17. haftada üç boyutlu ultrasonografi ile epigastrik heteropagus ikiz tanısı alan ve cerrahi olarak başarılı bir şekilde ayrılan olgu sunulmuştur.

A Rare Form of Heteropagus Twinning: Three-Armed Infant with Spinal Dysraphism

An ectopic or accessory limb attached to the back is an extremely rare and strange condition, and there are only a few documented cases in the worldwide literature. The first case was described by Jones and Larkin (1889). There are several theories regarding the origin of this condition. Asymmetric conjoined twinning which is located dorsally in the vertebral column (rachipagus) is the most probable diagnosis of our patient. Conjoined twinning is very rare and the incidence is 1 per 50 000 live births. Rachipagus is even rarer, with no more than 30 case reports so far (Chadha et al. (1993, 2006)). In this report, we present a patient who underwent successful surgical excision of a third arm attached to the back in the midline over the low-dorsal region. Differential diagnoses including teratoma and fetus in fetu are discussed.

The epigastric heteropagus conjoined twins

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.

Heteropagus twins-a tale of two cases.

Heteropagus twinning is a rare occurrence. Parasitic and asymmetric conjoined twins are rarer anomalies of monochorionic monoamniotic twins; which consist of an incomplete twin attached to the fully developed body of the co-twin. We present here two such cases of Heteropagus twinning.

A case report of an omphalopagus heteropagus (parasitic) twin

Heteropagus twin refers to a type of conjoined twin in which an incomplete smaller (parasitic) twin is attached to and dependent upon an otherwise normal host twin. The majority of cases have complete or partial duplication of the pelvis and/or lower extremities. The case depicted herein is unusual in that only isolated case reports have described an attached amorphous mass without identifiable limbs.

Epigastric Heteropagus Twin: Our Experiences of two cases with review of literature

Epigastric Heteropagus Twin: Our Experiences of two cases with review of literature

Conjoined Epigastric Heteropagus Twins: Excision of a Parasitic Twin from the Anterior Abdominal Wall of Her Sibling

Epigastric heteropagus twins (EHT) are an exceedingly rare form of asymmetric conjoined twins in whom the dependent twin (parasite) is attached to the right or left upper abdomen of the dominant part (autosite). Such a case observed at our institution with 34 month follow-up is presented here and the surgical technique described. A magnetic resonance imaging (MRI)-supported surgical separation of the parasite with successful closure of the abdominal wall defect of the autosite was performed. Follow-up studies showed an autosite which was alive and in optimal health. A comprehensive review including data from English and non-English literature is presented.