Doctors Save Life of One Conjoined Twins

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A 22-month-old conjoined twins survived the gut-wrenching decisions medical doctors in United States of America made in highly complicated medical case.

The choice was difficult for doctors at MassGeneral Hospital for Children: Separate twin girls from East Africa in a 14-hour surgery and save the stronger one, or do nothing and lose both children.

Without the operation, both would have perished, said the surgeons, who added they were tested technically and ethically.

“The major challenges we faced were coordinating the large, multidisciplinary team — including pediatric general surgery, orthopaedic surgery, plastic surgery, critical care, cardiology, radiology, nursing, palliative care, social work, ethics and the operating room staff — and confronting the ethical implications of an operation in which one twin was unlikely to survive,” said Dr. Allan Goldstein, the surgeon-in-chief at the children’s hospital.

“Navigating this complex territory was challenging, but worth it and extremely rewarding for everyone involved,” Goldstein said in a hospital news release.

Details of the 2016 surgery were published Oct. 26 in the New England Journal of Medicine.

A non-profit organization in the family’s home country helped the family secure the special care the girls needed in the United States.

“The girls were connected at the belly and the pelvis. They had three legs between them, one with a misshapen foot. They shared one liver, and each girl had one underdeveloped kidney and one complete kidney that drained into a shared bladder. Their digestive tracts were attached below the upper small intestine. And their pelvic structures were also combined,” their doctors recalled.

Complicating matters even further, the twins shared an arterial blood supply and one child was dependent on her sister’s circulatory system. This twin was also smaller, less alert and less interactive than her sister. Tests revealed she had serious heart defects.

The smaller twin had trouble pumping oxygen throughout her body, and had several episodes of respiratory distress that required admission to the intensive care unit. These developments led the doctors to determine she would not survive separation surgery.

Facing this ethical dilemma, the hospital’s paediatric ethics committee concluded that the girls should be viewed as separate patients. They noted, however, there was little chance they could save the smaller twin.

With the support of their daughters’ doctors and a religious leader, the parents ultimately decided to proceed with the separation surgery.

During the complex procedure, the smaller twin passed away as expected.

One year later, the larger twin is thriving. She can eat and stand with help and has progressed in her development. She is undergoing physical therapy and will need additional surgery to treat the malformation of her leg and foot.

Her parents have expressed gratitude for the counsel and care they received.

“Everyone here was united for our family’s cause,” they said. “We couldn’t be prouder or happier with how we all came together for the well-being of our child.”

Identical twins develop when a single fertilized egg, also known as a monozygote, splits during the first two weeks of conception. Conjoined twins form when this split occurs after the first two weeks of conception. The monozygote does not fully separate and eventually develops into a conjoined fetus that shares one placenta, one amniotic sac, and one chorionic sac. Because the twins develop from a single egg, they will also be the same sex. The extent of separation and the stage at which it occurs determine the type of conjoined twin, i.e., where and how the twins will be joined.

The proximity of the segments determines how much shared tissue there will be. The further apart the segments, the greater the likelihood that the organs will develop fully in each fetus. If the segments are at their farthest point, there will only be a minimum of tissue and cartilage joining the twins, i.e. omphalopagus twins will develop.

Isidore Geoffroy Saint-Hillaire was the first teratologist to classify conjoined twins, using Greek etymology to describe the twins in terms of their shared anatomy. Many of his terms are still in use today. Listed below are some commonly occurring types of conjoined twins, examples of which may be viewed throughout this exhibit.