Show authors biography
Heteropagus or “parasitic” twins are asymmetric conjoined twins in whom the tissues of a severely defective twin (parasite) are dependent at variable sites of the other intact twin (autosite) for nutritional supply and growth. Here we present the case of heteropagus twins. The parasite possessed two lower limbs and rudimentary upper limbs attached to the perineum and right buttock of the autosite. Although they did not share pelvic organs, the external compression of the parasite´s skeletal structures caused rectum stenosis on the autosite, which required surgical treatment. Imaging studies allowed presurgical planning for the twins´ successful separation with good survival and quality of life of the autosite. Although heteropagus twins have been described since ancient times, they still generate great interest due to the varying clinical manifestations and lack of knowledge on their pathogenesis.
Article visits 645 | PDF visits 1178
Downloads
1. Pare A. On Monsters and Marvels. United State: University of Chicago Press; 1995.
2. Edmonds LD, Layde PM. Conjoined twins in the united states, 1970-1977. Teratology. 1982;25(3):301-8. doi: 10.1002/tera.1420250306.
3. Martinez-Frias ML, Bermejo E, Mendioroz J, Rodriguez-Pinilla E, Blanco M, Egues J, et al. Epidemiological and clinical analysis of a consecutive series of conjoined twins in Spain. Journal of pediatric surgery. 2009;44(4):811-20. doi: 10.1016/j.jpedsurg.2008.07.002.
4. Ademuyiwa AO, Alabi EO, Idiodi-Thomas HO, Bankole OB, Elebute OA, Alakaloko FM, et al. Surgical management of pygopagus parasiticus in a developing country: Challenges and review of the literature. Journal of Pediatric Surgery Case Reports. 2015;3(2):58-62. doi: 10.1016/j.epsc.2014.12.003
5. Spencer R. Parasitic conjoined twins: external, internal (fetuses in fetu and teratomas), and detached (acardiacs). Clin Anat. 2001;14(6):428-44. doi: 10.1002/ca.1079
6. Poradowska W, Jaworska M, Reszke S, Lodzinski K. Conjoined twins and twin parasite: clinical analysis of three examples. Journal of pediatric surgery. 1969;4(6):688-93.
7. O'Neill JA, Jr., Holcomb GW, 3rd, Schnaufer L, Templeton JM, Jr., Bishop HC, Ross AJ, 3rd, et al. Surgical experience with thirteen conjoined twins. Annals of surgery. 1988;208(3):299-312.
8. Chadha R, Bagga D, Dhar A, Mohta A, Malhotra CJ, Taneja SB. Epigastric heteropagus. Journal of pediatric surgery. 1993;28(5):723-7.
9. Ozcan C, Ergun O, Guclu C, Tumuklu M, Alper H, Erdener A. An unusual case of epigastric heteropagus: parasite with a rudimentary heart. Journal of pediatric surgery. 2000;35(10):1523-5.
10. Jones R, Larkin FC. Removal of Accessory Limb and Meningocele from the Back of a Child, and its Anatomy. British medical journal. 1889;2(1493):310-1.
11. O'Rahilly R. Morphological patterns in limb deficiencies and duplications. The American journal of anatomy. 1951;89(2):135-93.
12. Sharma G, Mobin SS, Lypka M, Urata M. Heteropagus (parasitic) twins: a review. Journal of pediatric surgery. 2010;45(12):2454-63. doi: 10.1002/aja.1000890202
13. Kapur V, Kulkarni M, Shenoy M. Asymmetric conjoined twins. Pediatr Surg Int. 1997;12:308-9.
14. Ratan SK, Rattan KN, Magu S, Rohilla S, Purwar P, Mathur SK. Thoracolumbar rachipagus parasite. Pediatric Surgery International. 2004;20(4):298-300.
15. Spencer R. Rachipagus conjoined twins: they really do occur! Teratology. 1995;52(6):346-56.
16. Nanni L, Perrelli L, Velardi F. Accessory lower limb in a newborn with multiple malformations. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery [et al] = Zeitschrift fur Kinderchirurgie. 1994;4(1):51-3. doi: 10.1055/s-2008-1066068
17. Platt DJ, Miner JJ. Consequences of congenital Zika virus infection. Current opinion in virology. 2017;27:1-7. doi: 10.1016/j.coviro.2017.09.005.
18. Hamrick M, Eradi B, Bischoff A, Louden E, Pena A, Levitt M. Rectal atresia and stenosis: unique anorectal malformations. Journal of pediatric surgery. 2012;47(6):1280-4.
19. Cury EK, Schraibman V. Epigastric heteropagus twinning. Journal of pediatric surgery. 2001;36(7):E11.
20. Hager J, Sanal M, Trawoger R, Gassner I, Oswald E, Rudisch A, et al. Conjoined epigastric heteropagus twins: excision of a parasitic twin from the anterior abdominal wall of her sibling. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery [et al] = Zeitschrift fur Kinderchirurgie. 2007;17(1):66-71. doi: 10.1055/s-2007-964951
21. Husain AN, Muraskas J, Lambert G, Dado D, Lynch J. Parasitic conjoined twins with omphalocele and tetralogy of Fallot. Pediatric pathology. 1989;9(3):321-8.
22. Trainavicius K, Kazlauskas V, Gurskas P. Epigastric heteropagus conjoined twins. Journal of Pediatric Surgery Case Reports. 2013;1(5):114-7. doi: 10.1016/j.epsc.2013.03.012