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Images in Clinical Practice

Indian Pediatrics 1999;36:327

Epigastric Heteropagus

A 12-day-oId male baby was seen who had an incomplete parasitic twin attached to its epigastrium above an omphalocele (Fig. 1). The parasitic twin had well-developed lower limbs, a penis with urethra which was blind beyond its root, a poorly developed scrotum without testes, an anal dimple and a malformed upper limb with a single digit. The parasite showed no movements even on stimulation.

Fig. 1. Male baby with epigastric heteropagus. Note the small omphalocele ill the host baby. The parasite twin  had two well-developed lower limbs and a phallus.

As the parasitic twin did not cause any distress to its host, immediate surgical separation of the pair was not attempted. The baby was sent home advising conservative management of the omphalocele by regular application of mercurochrome over it. The pair thrived well and reported back about 2 months later, By this time, the omphalocele had healed almost completely. The parasite was excised successfully during this presentation, it had no visceral organs except two rudimentary kidney­like structures, confirmed later by histological examination. The host baby was doing well at follow-up 6 weeks later. Incomplete parasitic twin or heteropagus at the epigastric region is an extremely rare congenital malformation.

                             U.K. Borah,
Department of Pediatric Surgery,
                Gauhati Medical College,
                             Guwahati 781032,


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