Early separation of parasitic conjoined twins at a tertiary care hospital: A case report

Introduction: Conjoined twins is defined as twins that are physically fused in utero and at birth. Parasitic conjoined twins is a particularly rare form of conjoined twins, occurring in fewer than 1 in 1 million live births. The management of parasitic conjoined twins remains a challenge, lacking a universal consensus regarding the optimal timing for separation surgery. Case presentation: A 31-week pregnant woman presented with a fetal emergency. Ultrasound at 27 weeks revealed conjoined abdominopagus twins sharing a single liver. At 31 weeks, only one fetal heartbeat was detected, requiring an urgent cesarean section. Two asymmetric female twins were delivered: Neonate A, who survived with an APGAR score of 7/9, and Neonate B, a stillbirth. Neonate A had ventriculomegaly, while Neonate B exhibited multiple congenital anomalies, including bilateral cleft lip, hypodactyly, hydrocephalus, and hydrops fetalis. Neonate A was stabilized and underwent successful early separation surgery. Postoperatively, Neonate A received intensive care, including respiratory support, broad-spectrum antibiotics, and treatment for a patent ductus arteriosus. At one-month follow-up, Neonate A was stable and recovering well. Conclusion: Early separation of parasitic conjoined twins is recommended in cases with one stillborn or deceased twin, as it improves survival chances for the autosite. Delayed separation is advised for cases with two viable twins, allowing for organ maturation and reducing intraoperative complications.