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| NEUROIMAGES |
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| Year : 2017 | Volume
: 65
| Issue : 6 | Page : 1443-1444 |
Rachipagus parasitic twin
Amol Raheja, Ashok K Mahapatra
Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 10-Nov-2017 |
Correspondence Address:
Dr. Amol Raheja
Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.217969
How to cite this article:
Raheja A, Mahapatra AK. Rachipagus parasitic twin. Neurol India 2017;65:1443-4 |
We present an extremely rare entity of a rachipagus parasitic twin. A 2-year old male child presented to our outpatient services with a heteropagus twin attached to the dorsolumbar region (rachipagus) of host twin autosite. There were two rudimentary limbs (right and left arrow) with a single digit and a depression suggestive of an anal dimple (diamond arrow, [Figure 1]). Two primary groups of conjoint twins have been described – symmetric and asymmetric. The former has both twins of almost equal proportion symmetrically disposed and joined by corresponding parts. The latter, also termed as heteropagus, develops because of differentially increased placental blood flow to one twin and the consequent ischemic atrophy of the other twin resulting in a fetal-shaped lump, as well as accessory and differentiated end organs attached to the host twin. This entity most commonly affects female patients who usually show the manifestation of a ventral thoracic attachment; the dorsolumbar site of attachment (rachipagus) in male patients is extremely rare. Two primary theories of its embryogenesis exist: (a) the fission; and, (b) the fusion theory, with the latter being more widely accepted.[1],[2] The fission theory is based on an incomplete separation of two monoamniotic monozygotic twins, subsequent to an in-utero stimulus at developmental days 13 or 14. Contrary to that, the fusion theory is based on the disruption of the ectodermal layer between two developing monovular embryonic discs, occupying opposite aspects of a common amniotic cavity, thereby leading to fusion of two developing neural folds. Possibility of accompanying malformations such as patent ductus arteriosus, spinal dysraphism, atrial septal defect, club foot, gall bladder hypoplasia, syndactyly, rectovaginal fistula, and horse-shoe kidney at the autosite of the healthy twin should also be evaluated.[2] Rachipagus conjoint twins are extremely rare, but this possibility should be considered in the cases of well-developed abnormal tissue on dorsal midline of the spine. The differential diagnosis of a fetus-in-fetus or a teratoma needs to be ruled out. | Figure 1: Heteropagus twin attached to the dorsolumbar region (rachipagus) of host twin autosite. There were two rudimentary limbs (right and left arrow) with a single digit and a depression suggestive of an anal dimple (diamond arrow)
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given consent for images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Kaufman MH. The embryology of conjoined twins. Childs Nerv Syst 2004;20:508-25.  |
| 2. | Zhang J, Duan H, Zhang Y, Yi Z, Bao S. Parasitic rachipagus conjoined twins with spina bifida, diplomyelia, scoliosis, tethered cord syndrome and ventricular septal defect. Neurol Med Chir (Tokyo) 2011;51:736-9. |
[Figure 1]
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A cohort of five cases with asymmetric conjoined twining and literature review |
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| Xiufang Zhi, Bo Hu, Xuwen Zhao, Jing Chen, Chunyu Gu, Linjie Pu, Yulian Fang, Chunquan Cai | | Pediatric Surgery International. 2021; | | [Pubmed] | [DOI] | |
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