Parapagus dicephalus conjoined twins and evaluation of ischiopagus tetrapus conjoined twins in Indonesia: a case report

Abstract

Conjoined twins are rare occurrences in medical practice. In this study, two cases of conjoined
twins, parapagus dicephalus and ischiopagus tetrapus are reported in Dr. Sardjito General Hospital,
Yogyakarta, Indonesia. The first case i.e. five-day-old male parapagus dicephalus conjoined
twins referred to the hospital. The twins have two heads, two arms and two legs. X-ray examination
reveals two vertebrae collumn, single heart, and single pelvis. Moreover ultrasonography
examination reveals conjoining of liver and echocardiography examinatin reveals single atrium.
The twins were diagnosed as parapagus dicephalus. As a result of their fusion, operative care
had been considered to be unacceptable. After several weeks in neonatal intensive care, they
died. The second case i.e. two-day-old female conjoined twins with conjoining at ischium region
referred to the hospital. Ultrasonography and abdominal examination reveal conjoining at
intestinum, buttock and ischium. The twins was diagnsed as ischiopagus tetrapus. They were
successfully separated at 6 months of age. They are alive and well so far for more than 7 years.
In conclusion, the prognosis of conjoined twins is related to the type, extent of union and organ
abnormalities. The successful separation of conjoined twins might be determined by good planning
and staff enthusiasm and dedication.