Kasagga Brian, Basiimwa Roy Clark, Ssewanyana Yasin, Nimanya Stella, Nassanga Rita, Sekabira John
Department of Surgery, Mulago National Referral Hospital, Uganda.
Department of Radiology, Mulago National Referral Hospital, Uganda.
Int J Surg Case Rep. 2025 Oct;135:111920. doi: 10.1016/j.ijscr.2025.111920. Epub 2025 Sep 8.
Conjoined twins represent a rare medical phenomenon that poses significant clinical and ethical challenges, particularly in resource-limited settings.
We present a case of conjoined twins delivered at 39 weeks gestation to a 27-year-old refugee mother. The delivery was by emergency cesarean section due to footling breech presentation. Initial assessments revealed shared cardiac anatomy, with Twin A exhibiting a more favorable anatomical structure compared to Twin B, who presented with severe cardiac malformations. Follow-up imaging, including CT angiography, uncovered additional complexities, such as dextrocardia and situs inversus in Twin A, raising further challenges regarding surgical separation.
Management required a multidisciplinary discussion involving social worker, nurses, pediatric surgeons, neonatologists, pharmacist, nutritionist, pediatric cardiac surgeons, radiologists, and anesthesiologists to address both clinical challenges and the ethical considerations surrounding separation in the context of one twin with unfavorable anatomy. The team emphasized tailored care and adjustment of medication dosages due to the shared circulatory system of the twins. Despite the team's efforts, both twins succumbed to heart failure.
This case highlights the clinical and ethical complexities of managing conjoined twins with shared vital organs in a low-resource setting. It underscores the importance of advanced imaging, multidisciplinary planning, and social support;- especially for vulnerable populations like refugees. Strengthening antenatal care, including routine obstetric ultrasound, is essential for early diagnosis, timely referral, and improved outcomes.
联体双胎是一种罕见的医学现象，带来了重大的临床和伦理挑战，在资源有限的环境中尤为如此。
我们报告一例联体双胎病例，孕39周时由一位27岁的难民母亲分娩。由于足先露臀位，通过急诊剖宫产分娩。初步评估显示心脏解剖结构共享，与双胎B相比，双胎A的解剖结构更有利，双胎B存在严重心脏畸形。包括CT血管造影在内的后续影像学检查发现了更多复杂性，如双胎A存在右位心和内脏反位，这给手术分离带来了进一步挑战。
管理需要多学科讨论，涉及社会工作者、护士、小儿外科医生、新生儿科医生、药剂师、营养师、小儿心脏外科医生、放射科医生和麻醉科医生，以应对临床挑战以及在一个双胎解剖结构不利的情况下分离所涉及的伦理考量。由于双胎共享循环系统，团队强调了个性化护理和药物剂量调整。尽管团队做出了努力，但两个双胎均死于心力衰竭。
本病例突出了在资源匮乏环境中管理具有共享重要器官的联体双胎的临床和伦理复杂性。它强调了先进影像学、多学科规划和社会支持的重要性，特别是对于难民等弱势群体。加强产前护理，包括常规产科超声检查，对于早期诊断、及时转诊和改善结局至关重要。
