EXPANSION AND DIVISION OF CONJOINED TWINS

Omphalopagus conjoined twins were born by cesarean section after their 24-year-old gravida 2, para 1 mother went into labor at 35 weeks' ges tation. Initial studies included roentenograms, an upper gastrointesti nal study, small bowel follow-through, and computerized tomography wit h intravenous contrast from neck through pelvis. Results of these stud ies showed that the twins had very little shared vasculature, but did share a pericardium and liver parenchyma. The infants were allowed to gain weight and grow. After 3 weeks, tissue expanders were placed subc utaneously and were rapidly expanded in 2 weeks. The infants were then separated. An Argon Beam Coagulator was used to aid the separation of the liver. The abdominal fascia was closed primarily on each infant, and the skin easily closed without tension. During the first 36 hours of the postoperative course, both infants required significant ventila tory support including inhaled nitric oxide. After this period, the ve ntilatory support decreased dramatically and rapidly. The infants were discharged 9 days after their surgical separation. Conjoined omphalop agus twins, the use of tissue expanders and the Argon Beam Coagulator, and the postoperative course are discussed. Copyright (C) 1998 by W.B . Saunders Company.