Heteropagus twins: six cases with systematic review and embryological insights
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In brief
In brief
Systematic review of 120 heteropagus (parasitic) twin cases found rachipagus and omphalopagus as most common variants, with 14% of autosites having congenital heart disease. Autosite survival is generally favorable, but outcomes depend primarily on cardiac anomalies rather than twin anatomy alone.
Written by the GCMD Library team from the article.
Abstract
Purpose
Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described.
Methods
Six cases of HT managed at two tertiary care teaching hospitals over the last 26 years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed.
Results
Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived.
On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases.
Conclusion
Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance.
Level of evidence
IV.