Multimodality Management of Two Pairs of Pyopagus Twins

Abstract

Background and Aim: Conjoined twins, due to their rarity and complex anatomy, pose not only a technical, but also a physiological challenge for their separation, with each case being uniquely distinct. The aim of the present article is to describe the surgical approach and management strategy for two cases of pyopagus conjoined twins operated at our center. Case Report: Case 1: Antenatally detected conjoined twin girls presented postnatally to our centre. They were found to have a common vestibule with single anal opening facing partially away from each other. On evaluation they were found to have a single sacrum and fused conus and filum terminale. They were taken up for separation at 2years of age & the 24hour long surgery, culminated in successful separation. The children had good post-operative outcome at 10months post separation. Case 2: Conjoined pyopagus twin girls presented postnatally, and were found to have fused cords, having a terminal syrinx and partially separate sacrum. They were separated at 2.5 years of age, with a multi-departmental effort and coordination. They are doing well 2 months post-operatively. Conclusion: A multidisciplinary team support with thorough preoperative planning significantly aids in improving the outcome of surgical separation. This has been possible by using modern technology. Each reported case contributes significantly to literature.