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Background: A pair of female ischiopagus tetrapus conjoined twins were transferred to our hospital when they were 3 days old and with a total weight of 3850 g. They were fused face to face from the umbilicus to the pelvis at an angle of 60 degrees. There was a single umbilicus ventrally. The twins shared an anus, and each infant exhibited a urethral and two vaginal orifices.
Methods: A series of radiological examinations showed two separate normal upper tracts, two small intestines joined at the common terminal ileum, a single cecum, and a common colon connected with an anus in twin A. They had two retropubic bladders close together as a large bladder with a very thin midst membrane, two sacrums faced each other and division of pubic symphysis. Separation surgery was performed on the twins at the age of 3 months.
Results: The surgery lasted for 4.5 hours. Both infants were transferred to the Neonatal Intensive Care Unit (NICU) after the operation. Twin A died 6 hours after the operation for unknown reasons. Twin B survived and the follow up showed that she became a normal and healthy girl.
Conclusions: Ischiopagus conjoined twins are rare and their separation is more difficult for the variable anatomy. Careful preoperative evaluation and planning are very important. The connecting bridge should be enlarged sufficiently before operation so as to repair the abdominal wall.
Key words: conjoined twins; ischiopagus; tetrapus; separation; surgery
World J Pediatr 2007;3(3):228-231
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