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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.
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