The First Successful Separation of Conjoined Twins – Thoracoomphalopagus in RSUP Prof R. D. Kandou Manado: A Case Report

Abstract

Conjoined twins, a rare congenital anomaly, occur in approximately 1 out of every 100,000 births, and not all cases result in survival. Only about 25% of conjoined twins who are born alive survive and then decide whether they can be separated or not. This separation of conjoined twins is the first case carried out in our institution. These thoraco-omphalopagus conjoined twins experience partial union of the sternal bone, diaphragm, liver, epigastric abdominal wall to infraumbilical. The imaging process showed the appearance of a small vascular shunt between the liver of twin A and the liver of twin B children, and vascularity and other organs that were visualized normally and were present in each of the two twins so that elective separation was decided. Hepatic union occurs in hepar segments 2 - 3 from the right direction (twin A) merging with segments 4a and 2 from the left direction (twin B). Hepatic resection between these segments is done without problems, no bleeding and bile leakage. The sternal bone and xyphoid process are surgically cut, followed by suturing the anterior diaphragm to the new lower end of the sternum. Closure of the abdominal wall, along with umbilicoplasty, is then carried out without tension. Intraoperative and postoperative respiratory and hemodynamic status is progressing well and signs of abdominal compartement syndrome also do not occur. Separation of conjoined twins cases can be done effectively with careful consideration as long as there is no emergency in one of the babies.