Heteropagus (parasitic) twins and concomitant omphalocele: A case report

Heteropagus twins are extremely rare, occurring in one to two million live births. To date, fewer than 75 cases of epigastric heteropagus twins have been reported, and only a handful of these cases have involved heteropagus twins with a concomitant omphalocele. We present a case of heteropagus twins in a 2-day-old neonate with a fully formed parasitic mass attached to the lower anterior chest wall and epigastrium. The parasitic twin was acephalic and acardiac, had bowel structures, pelvic bones, bilateral lower limbs, and a single upper limb. The blood supply of the parasitic twin primarily originated from the right internal mammary artery, and the venous return was via the right internal mammary vein to the superior vena cava. The parasitic twin's bowel loops overlapped the left lobe of the autosite's liver, which was partially contained in a midline omphalocele-like abdominal wall defect. The autosite also had a small patent foramen ovale and a patent ductus arteriosum with a left-to-right shunt. A successful dissection and excision of the parasitic twin was done to remove the rudimentary limbs, pelvis, and part of the parasitic trunk. The autosite's omphalocele was repaired at the same time. The patient had an uneventful postoperative recovery. Early surgical separation of heteropagus twins is crucial to optimize the outcomes of the healthy twin.