Rachipagus Parasitic Twin With Epithelialized Myelomeningocele in a Rural Ethiopian Neonate: A Case Report

Rachipagus parasitic twinning is an exceptionally rare clinical entity resulting from an asymmetric monozygotic twinning process, characterized by a dorsally co-joined partially formed twin. Co- existence of this condition with neural tube defect is uncommon, yet clinically significant. In this paper, we report a neonate who presented with a lumbosacral limb-like mass and an epithelialized myelomeningocele. Clinical examination showed reduced lower-limb movements and diminished anal reflex. Investigation with MRI demonstrated posterior vertebral dysraphism, tethered cord, and an externally attached mass containing partially formed osseous elements without visceral organ sharing. Multidisciplinary team planning for complete excision of the parasitic mass with simultaneous myelomeningocele repair and tethered cord management was undertaken at our center, followed by referral to a specialized neurosurgical facility; however, detailed data regarding the management of the neonate after refferal to neurosurgical center could not be obitained due to lack of unified electronic recording system and fragemented refferal pathways and systemic barriers that limited the patient to continue follow up. This case highlights a rare finding that is of significance to clinical and scientific learning, but also the challenges of delivering and sustaining specialized surgical care in low-resource settings, as well as follow- up and documentation of outcomes.