SURGICAL SEPARATION OF CONJOINED (SIAMESE ) OMPHALOPAGUS TWINS AT 2 WEEKS OF AGE

Background. - Conjoined (siamese) twins represent a rare situation whi ch may occur in 1 of every 50,000 births. A prenatal diagnosis usually lends to stopping pregnancy. We report a case with successful surgica l separation at the age of 15 days. Case report. - Ultrasonographic ex amination at 20 weeks of gestation showed omphalopagus siamese joined at the abdomen from the xiphoid process to the umbilicus. Conjoined st ructures included liver. There was a multicystic right kidney in one t win, without other malformation. Karyotype was normal, 46XX. The mothe r refused interruption of her pregnancy. Both girls were born by cesar ean section. Angiography, magnetic resonance imaging and intravenous u rography confirmed the ultrasound examination. There was no cross circ ulation into the liver and the gastrointestinal tract was nor conjoine d. The twins were separated at 15 days of age with right heminephrecto my of the multicystic kidney. The girls are now 16 months old and are in very good health. Conclusion. - Prognosis of siamese twins depends on the nature of joined structures and presence of malformations. Ultr asonographic examination during pregnancy shows the possibility of sur gical separation, which is performed by a double anesthetic and surgic al pediatric team. Preoperative investigations must include MRI.