A rare presentation of heteropagus conjoined twin: a case report with review of literature

Conjoined twins are a rare occurrence with an incidence of about 1 in 100000 pregnancies. Our case is that of a 32 year old multigravida patient who came to us at 17 weeks gestation with a scan done at 14 weeks suggestive of severe spinal dysraphism with lumbar meningomyelocele spina bifida at multiple levels with protuberant abdomen. The patient opted for medical termination of pregnancy which was carried out after due to consent. The patient aborted after 12 hours. Further inspection of the abortus revealed it to be conjoined twins with one apparently normal head and thorax with a large omphalocele with 4 lower limbs. There were two caudal halves along with two sets of lower limbs and external genitalia arising from the abortus perpendicular to it on either side of the thorax. One set of arms was attached to the thorax and yet another arm and a limb bud were arising from the other end of the fetus attached to a rudimentary head like structure. Heteropagus tetrapus twins are an extremely rare form of parasitic twins. Inspite of advances in surgical techniques and methods, the morbidity endured by the affected neonates is very high. Thus prenatal diagnosis of conjoined twins along with the option of termination of pregnancy is of utmost importance.