Ischiopagus Conjoint Twins: A Case Report

The birth of conjoined twins is an extremely rare neonatal condition, occurring in approximately 1 in 100,000 live births. Ischiopagus, a form of conjoined twinning where the twins are joined at the pelvis, accounts for 6-11% of all conjoined twins. Ischiopagus conjoined twinning is a congenital anomaly. The surgical separation of conjoined twins is challenging due to the intricate anatomy and physiology involved. Thorough preoperative evaluation, meticulous planning, and a skilled surgical team are essential for ensuring a successful outcome. This condition significantly requires separation surgeries due to the unique anatomical challenges it presents. Clinical outcomes can vary depending on the healthcare facility and resources available. The development of conjoined twins consistently draws significant attention from researchers and clinicians. Aside from the rarity of such cases, the manner in which these twins develop remains a topic of ongoing debate. This report describes a case of ischiopagus conjoined twins, characterized by two heads (dicephalus), four upper limbs (tetrabrachius), and a shared pelvis with single umbilical cord. The mother of the twins was referred from a primary hospital Somali Sudanese Specialized Hospital for specialized care during her twin pregnancy, where a cesarean section was performed.

The twins delivered by 34 years old gravida 9 para 7, no previous congenital anomalies, the mother was diabetic and she was on anti-diabetic drugs. Both parents had no family history of birth defects or exposure to known teratogens. Imaging (MRI) revealed that that the twins had separate hearts, lungs, kidneys with severe hydronephrosis in one of them, stomach, liver, spleen, and anal canals but shared the bowel loops, a single placenta with one umbilical vein and two umbilical arteries with single umbilical cord. Additionally, they have uterus-like structure with the absence of external genitalia. Despite multiple associated cardiovascular anomalies, there were no external craniofacial, limb, or brain abnormalities. The twins admitted for the neonatal ICU and observed with normal meconium and urinary passage from same opening (cloaca).