Acute abdominal pain in a separated conjoined twin

Complications of conjoined twins are typically events surrounding the birth and surgical separation. We report an unusual late-onset complication, a grade IV duodenal disruption of the accessory system in a formerly conjoined twin. Because conjoined twins have unique anatomy based on the junction and division of organs, one must always consider a multitude of causes for common complaints. Basic operative principles apply: the acute abdomen must be explored. Finally, to avoid these complications, removal of all or nearly all parasitic structures must be considered at the initial separation.