WOFAPS 2025 8th World Congress of Pediatric Surgery

Faisal Nugud ¹, Abdelrahman Elnour ², Leena Abdelmagid ³, Moataz Idriss ³

¹ University of Gezira
² National Centre of Pediateric Surgey
³ Sudan Medical Specialization Board

Introduction: Epigastric heteropagus twins are a rare form of asymmetrical conjoined twinning in which a well-developed autosite supports a parasitic twin, typically attached to the upper abdomen. Early diagnosis and multidisciplinary management are critical for optimal outcomes.

Case Presentation: We report the case of a 28-year-old pregnant woman, gravida 3 para 2, who was on regular antenatal follow-up. A twin pregnancy was identified during the first trimester. In late pregnancy, detailed imaging raised suspicion of conjoined twins. Due to a previous cesarean section, delivery was planned and performed via elective cesarean section. The outcome was a live, healthy female infant accompanied by an epigastric heteropagus twin. The parasitic twin presented with a well-developed head and neck but lacked a trunk and limbs. The autosite was admitted to the neonatal intensive care unit for monitoring and comprehensive evaluation. Investigations included full blood count, renal and liver function tests, echocardiography, and computed tomography to assess the extent of internal connections. At 10 days of life, surgical separation was successfully performed by a multidisciplinary team comprising pediatric, plastic, cardiothoracic surgeons, and anaesthetist. The procedure involved careful separation and reconstruction of the anterior abdominal wall. Postoperative recovery was uneventful. Oral feeding was initiated on postoperative day 3, and the infant was discharged in stable condition on postoperative day 7.

Conclusion: This case highlights the importance of prenatal diagnosis, multidisciplinary planning, and timely surgical intervention in managing rare cases of epigastric heteropagus twins. Early coordinated care can lead to excellent surgical and functional outcomes.