Abdi Shakur Abdihakim Elmi, Halane Salad Ahmed, Farah Farah Yusuf
General Surgery Department, Hodan Hospital, Mogadishu, Somalia.
Department of Reproductive Health, Ministry of Health, Galmudug, Somalia.
Int Med Case Rep J. 2025 Aug 7;18:985-989. doi: 10.2147/IMCRJ.S525402. eCollection 2025.
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).
联体双胎的出生是一种极其罕见的新生儿疾病，发生率约为每10万例活产中有1例。坐骨联体双胎是联体双胎的一种形式，即双胞胎在骨盆处相连，占所有联体双胎的6% - 11%。坐骨联体双胎是一种先天性畸形。由于涉及复杂的解剖结构和生理功能，联体双胎的手术分离具有挑战性。全面的术前评估、精心的规划以及技术娴熟的手术团队对于确保手术成功至关重要。由于这种疾病所呈现的独特解剖学挑战，其分离手术的需求非常迫切。临床结果可能因可用的医疗设施和资源而异。联体双胎的发育一直吸引着研究人员和临床医生的极大关注。除了此类病例的罕见性之外，这些双胞胎的发育方式仍然是一个持续争论的话题。本报告描述了一例坐骨联体双胎病例，其特征为双头（双头畸形）、四条上肢（四臂畸形），以及共用一个骨盆且有单条脐带。双胞胎的母亲在怀双胞胎期间从索马里苏丹专科医院转诊至一家主要医院接受专科护理，并在那里进行了剖宫产。
这对双胞胎由一名34岁、孕9产7的产妇分娩，此前无先天性异常，母亲患有糖尿病且正在服用抗糖尿病药物。父母双方均无出生缺陷家族史或已知致畸物接触史。影像学检查（MRI）显示，双胞胎有各自独立的心脏、肺、肾脏（其中一个肾脏有严重肾积水）、胃、肝脏、脾脏和肛管，但共用肠袢，有一个单胎盘，一条脐静脉和两条脐动脉，有单条脐带。此外，他们有类似子宫的结构，没有外生殖器。尽管存在多种相关的心血管异常，但没有外部颅面、肢体或脑部异常。这对双胞胎被收入新生儿重症监护病房，观察到胎粪和尿液从同一个开口（泄殖腔）正常排出。
