Pygopagus conjoined twins are very rare, and half of all pygopagus twins have other anomalies. This report describes the successful surgical separation of pygopagus twins who had a conjoined thecal sac and an epidermal cyst. Meticulous preoperative planning, development of a model simulator, multispecialty teamwork, and a staged surgery contributed to a successful outcome.
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Anesthetic Strategies and Challenges in the Separation of Pygopagus Conjoined Twins: A Case Report.
Am J Case Rep
October 2024
Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
Article Synopsis
- Conjoined twins, specifically pygopagous twins, present unique surgical and anesthetic challenges, requiring a structured and well-coordinated approach for separation surgeries.
- The case involved female twins conjoined at the sacral level with complex additional conditions, leading to multiple surgeries including meningocele repair and anal canal dilation prior to their separation at 17 weeks of age.
- Successful anesthetic management was achieved through careful planning, effective teamwork, and the use of color-coded systems to minimize errors, demonstrating the importance of detail and communication in complex medical situations.
Parasitic pygopagus conjoined twins' incidental findings in the obstructed labor of an intrapartum dead baby that had undergone emergency C-section: rare case report in South Papua.
Childs Nerv Syst
August 2024
Emergency Department, Bunda Pengharapan Hospital, Merauke, South Papua, Indonesia.
Background: Conjoined twins (CT), which used to be historically defined as "monstrous human" and previously so-called Siamese twins in the early eighteenth century, are one of the very rare congenital malformations with an uncertain etiology and complex yet remain inconclusively debatable regarding its pathophysiological mechanisms of fusion and fission theories. Among all types of CT, parasitic CT, especially the pygopagus sub-type, is exceedingly rarer. To the best of the authors' knowledge, no parasitic CT had been reported in Papua, and this is the first finding in South Papua.
View Article and Find Full Text PDFCraniorachipagus symmetric conjoined twinning: Identification of a fourth case and delineation of the phenotype.
Birth Defects Res
July 2023
Department of Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
Background: Symmetric craniorachipagus is an exceedingly rare type of bi-umbilical conjoined twinning, known from only three scantily described cases.
Case: We identified a fourth, previously described case that was misdiagnosed as janiceps and as pygopagus. It concerned dorsally conjoined twins that were part of a triplet pregnancy, spontaneously born at 22 weeks of gestation.
Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls.
Childs Nerv Syst
July 2023
Neurosurgery department, Ain Shams University, Cairo, Egypt.
Pygopagus twin is a rare congenital malformation with a worldwide incidence of 1in 200,000. Few literature reports are published regarding the matter. In some cases, neuromonitoring is essential for safe surgical separation.
View Article and Find Full Text PDFThe role of intraoperative neuromonitoring in pygopagus separation: two-institution experience in Indonesia.
Childs Nerv Syst
May 2023
Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Introduction: Pygopagus comprises 17% of all conjoined twin cases. Survival rate is higher compared to other variations of conjoined twins, but separation is a great challenge due to multiorgan involvement. Intraoperative neuromonitoring (IONM) used aims to aid operator in preserving as much function as possible.
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