Epigastric Heteropagus Twin in a Term Neonate: Early Diagnosis, Multidisciplinary Separation, and Favorable Outcome:...

Epigastric heteropagus twinning is an extremely rare form of asymmetric conjoined twinning, characterized by a parasitic twin attached to the upper abdomen of a structurally normal autosite.

We report a full-term female neonate born via elective cesarean section with an epigastric heteropagus parasitic twin. The parasitic twin had a well-formed head and neck with a rudimentary trunk, and absence of limb structures. The autosite was clinically stable, with normal cardiovascular and respiratory status, and no congenital anomalies were detected on echocardiography. Contrast-enhanced computed tomography revealed a well-formed calvarium and cervical spine in the parasitic twin, absent thoracic and abdominal organs, and two major feeding vessels from the autosite. There was no visceral sharing. Surgical separation was performed on day 10 of life by a multidisciplinary team. Both feeding vessels were carefully ligated, the parasitic twin was completely excised, and the anterior abdominal wall was reconstructed. Postoperative recovery was uneventful; oral feeding resumed on day 3, and the infant was discharged on day 7. At 9-month follow-up, growth and developmental milestones were normal, with no evidence of hernia or other complications.

Early separation of epigastric heteropagus twins is safe and effective when there is no visceral sharing, the vascular anatomy is clearly defined, and multidisciplinary planning is implemented.