Case of parasitic conjoined twin

Parasitic conjoined twin
A: Preoperative view of the 9-month-old girl with an extra pair of lower extremities attached at the midline of the dorsal cervicothoracic junction. B: Preoperative MR image revealing cervicothoracic diplomyelia in addition to a full pelvis and lower extremities and a rudimentary scapula. C: The parasitic mass was successfully excised en bloc; the duplicated spinal columns were left untouched. D: By the 6th postoperative week, the patient was noted to be healing well with no neurological compromise. Figure is available in color online only.

Rachipagus – a rare conjoined twin subtype

A parasitic twin is a rare developmental anomaly in which an asymmetrical, nonviable conjoined twin is attached to the body of the host at the time of birth. This article describes the case of a 9-month old girl who presented with a rachipagus parasitic twin with a set of fully developed lower extremities originating from the midline upper back. Rachipagus is known as the rarest of conjoined twin subtypes, featuring a parasitic twin mass attached at the spine. The surgeons successfully excised the mass with a multidisciplinary approach and the resulting defect was closed in a single stage.

Case study: parasitic conjoined twin

9-month-old, full-term female infant presented to Advocate Children’s Hospital in Park Ridge, Illinois for evaluation of an extra pair of limbs attached to the upper dorsal midline. The parent’s personal issues did not allow the parents to accompany the child, doctors gained access to limited birth and medical history information through local interpreters. The patient’s history revealed that she was born in West Africa, via an uncomplicated vaginal delivery. Examination showed that she could sit unsupported and had normal functioning of her native lower extremities. However, she did not yet crawl. The patients weight was 15 lbs (1st percentile) and her height was 24 inches (8th percentile). Her head circumference was 44 cm. Physical examination showed that the infant was well-developed. A pair of fully developed extremities originated from the patient’s cervicothoracic midline, the extremities also showed apparent sensation and spontaneous movement in the toes.

Doctors advised a preoperative CT scan and MRI which showed a full bony pelvis, extremities originating from the craniocervical junction, a rudimentary scapula at the cervicothoracic junction. Two separate cervical canals with a patent neural foramina were also present, consistent with cervicothoracic diplomyelia. The posterior arches of the cervical vertebrae were not present. There were no other organ system anomalies. The parasitic twin was supplied with a distinct vascular pedicle, with the artery arising from the aortic arch. Whereas the vein drained into the superior vena cava through the paired azygos veins within the epidural space.

Operation and postoperative course

A multidisciplinary team including pediatric neurosurgery, pediatric orthopedic surgery, and pediatric plastic surgery excised the parasitic twin. Genetic analysis showed that the autosite and parasite both had identical DNA. By the 6th week, the patient was seen to be healing well. There were no signs of neurological compromise and the baby was seen to be recovering well.

Source: JNS

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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