Author/Authors :
Bahador, Ali Department of Pediatric Surgery - Namazee Hospital - Shiraz University of Medical Science - Shiraz, Iran , Foroughi, Mehdi Department of Pediatric Surgery - Namazee Hospital - Shiraz University of Medical Science - Shiraz, Iran , Sahmeddini, Mohammad Ali Shiraz Anesthesiology and Clinical Care Research Center - Shiraz University of Medical Science - Shiraz, Iran , Nikeghbalain, Saman Namazee Hospital - Shiraz University of Medical Science - Shiraz, Iran , Beizavi, Zahra Shiraz University of Medical Science - Shiraz, Iran , Eghbal, Mohammad Hossein Shiraz Anesthesiology and Clinical Care Research Center - Shiraz University of Medical Science - Shiraz, Iran , Vafaei, Homeira Maternal Fetal Medicine Research Center - Perinatology Ward - Shiraz University of Medical Science - Shiraz, Iran , Malekhosseini, Ali Namazee Hospital - Shiraz University of Medical Science - Shiraz, Iran , Bahador, Mohsen Department of Otorhinolaryngology - Shiraz University of Medical Science - Shiraz, Iran
Abstract :
Conjoined twins are derived from the division of a single fertilized
ovum; a phenomenon accompanied with multiple congenital
anomalies. Such twins are identical, of the same sex, and more
likely to be female. Most twins die during the embryonic period,
and only 18% survive longer than 24 hours. There are complex
anomalies in thoraco-omphalopagus twins that makes them
unlikely to live long enough to undergo separation. Treatment of
this uncommon condition presents both surgical and anesthetic
challenges. The management of rare anomalies is difficult even
for skilled surgeons. Therefore, it is logical to use the knowledge
gained from previous experiences.
We herein present the first successful surgical separation of
two pairs of thoraco-omphalopagus conjoined twins at the
Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran).
In both cases, the neonates had separate hearts and common
pericardium. Contrast-enhanced computed tomography of two
sets of twins showed fusion of sternum, pericardium, diaphragm,
and left lobe of liver. Critical steps of the surgical separation
were identified and contingency plans were made for possible
partial liver donation and cross-circulation between twins. The
separation procedure and reconstruction of the abdominal wall
were successfully performed. Both pairs of twins, now 6- and
8-year-old, are healthy and have normal growth and are under
follow-up.
Keywords :
Reconstructive surgical procedures , Congenital abnormalities , Twins, conjoined
