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A set of female ischiopagus tetrapus twins were born to a primigravida mother.
The pregnancy and vaginal delivery were essentially uneventful. The babies were
fused at the pelvis, their trunks being joined together in the same longitudinal
axis with the head and thorax of each at opposite poles (Fig. 1).
Cephalad to their common umbilicus, each twin appeared entirely normal. The four
lower extremities were oriented at right angles to the axis of the common trunk.
Posteriorly, the area of fusion was represented by the external genitalia and
fused buttocks (Fig. 2). There was a single cloacal opening for one of
the twins, whereas the labia of the other twin harboured an opening which
drained urine.
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Fig. 1. Anterior
view of ischiopagus tetrapus twins |
The babies were nursed in strict isolation for next seven and half months. The
investigations done during the intervening period revealed that both had a
common large intestine which also communicated with both the urinary bladders
before opening onto one of the twins' perineum. The urinary bladders were
eccentrically placed and drained the kidney from each twin in a mirror image
pattern. The complex cloaca also received two pairs of fallopian tubes; no
separate uteri or vaginae were present. The internal anatomy, steps of surgical
separation and outcome are detailed elsewhere(1).
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Fig. 2. Posterior view of
ischiopagus tetrapus twins. |
Conjoined twins occur once in 50,000-1,00,000 births and only 6% of the
con-joined twins are of the ischiopagus type(2). Tetrapus is a subtype in which
all four lower extremities are present. Surgical separation for ischiopagus
tetrapus twins have been attempted in about a dozen cases worldwide.
Y.K. Sarin,
J.K. Mahajan,
Pediatric Surgery Unit,
Department of Surgery,
Christian Medical College,
Ludhiana 141 008, Punjab, India.
1.
Sarin YK, John J, Thambudorai R. Genitourinary abnormalities in
ischiopagus tetrapus conjoined twins. Indian
J
Ural (in press).
2. Somasundaram K, Wong KS. Ischiopagus tetrapus twins. Br
J
Surg 1986; 73: 738-741.
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