2
42
1
2
possible underreporting in Nigeria. It is hoped that this
report will be an important contribution to the few exist-
ing publications in the country. Although a small num-
ber of centers in the country have reported survival of
conjoined twins, of note is that information on follow up
morbidity and mortality were generally lacking. Our
surviving conjoined twins were followed up for catch-up
growth, psychomotor development, presence of organ
dysfunction and possible late complications of the sur-
gery. All these parameters turned out to be normal at the
age of three years. Due to the complexity of the surgical
separation, a follow up to evaluate long term survival
and quality of life is useful reviewing surgical interven-
tion in the future. In the recent3case of separation of het-
favourable outcome following surgery. In contrast to
reports from other parts of the world, the author is un-
aware of any report of adult conjoined twins in the coun-
try. This situation may not be surprising as these babies
might have been deprived of care and left to die largely
because of stigma, poverty and ignorance. The current
case required a lot of psycho-social support for the
young parents who had initially abandoned these babies.
On the contrary the Biddenden Maids, born in England
in 1100, were famous and lived for 34 years. The
Siamese twins were also wealthy and famous in the
United States. We suggested that providing national
awareness, special government support and opening
national conjoined twins’ registry will go a long way in
improving the outcome of these babies, especially when
surgery pose a survival risk to one or both twins.
1
eropagus twins in Maiduguri, the twins had major re-
constructive surgery, consequently, long term follow up
of these twins will be complementary to our knowledge.
All three sets of conjoined twins seen at our center were
females, which is in keeping with the female preponder-
ance noted in the literature. Four out of the six babies
suffered early neonatal deaths while 2 (index twins) sur-
vived at 3-year follow up. Due to paucity of data it is
difficult to say, with any degree of accuracy, what the
still birth rate or neonatal death rate for conjoined twins
in the country is. Three of the reported 18 pairs where
still born, all the reported live born had surgery, 11 in
Nigeria and 4 abroad (Table I). Six out of the eight ba-
bies (75%) operated abroad survived (one baby was sac-
rificed to save the other twin). Twelve out of 22 babies
Conclusion
There is under reporting of conjoined twins in Nigeria
compared to other parts of the world. Experience from
available literature showed that these can be largely pre-
vented by demystifying the condition, providing more
awareness and support for the families. These measures
will go a long way to improving reporting as well as
enhancing the survival of these babies. Secondly paedia-
tricians and surgeons in Nigeria might want to review
their decisions to separate when the risk to one or both
twins is greater than the risk without the procedure.
(
54%) operated in Nigeria survived. Success rate was
fairer with ischio/pygopagus twins (58.3%) and poor
with thoraco/omphalopagus twins, especially when in-
ternal organs are shared.
Authors’ contribution
Amuabunos AE, Eregie CO, Omoigberale AI
Effiong V: All managed the patient and reviewed the
manuscript
A careful review of the current case with surgeons in our
institution and consult with other surgeons within and
outside the country informed the choice of having the
surgery done abroad to improved the chances of survival
of both twins considering the shared organs. This re-
flects the need to build on the already existing capacity
to handle such cases.
Conflicts of interest: None
Funding: None
While some have questioned the decision to separate
conjoined twins “when two are born as one”, having the
Acknowledgement
2
twins separated may seem justified if it is adjudged that
one or both twins would die without separation. This is
the case in some heteropagus twin situations in which
the parasite twin may die and/or cause the host twin seri-
ous physiologic embarrassment due to vascular, biliary
or enteric anastomosis. Even though our omphalopagus
twins are likely to survive into adulthood, the decision to
separate was preferential because of the expected
The authors acknowledge with gratitude the assistance
of the management of the Narayana Hospital in Banga-
lore, India and the surgical team especially Professor
Asley D’Cruz. We also thank the surgical team at the
university of Benin Teaching Hospital under the leader-
ship of Professor Evbounwan for their expert and pro-
fessional contribution to the care of the babies.
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