Separation of omphalopagus conjoined twins with ruptured omphalocele, complex biliary sharing and a choledochal cyst

Publication date: Available online 5 June 2019Source: Journal of Pediatric Surgery Case ReportsAuthor(s): Daniel K. Robie, Nicholas Poulos, Stephen DunnAbstractOmphalopagus sharing is the second most common type of conjoining following thoracopagus conjoined twins [1]. By definition there is an absence of a cardiac sharing or open connection though there can be a fibrous nonpatent connection between the hearts, sharing or fusion of the pericardial sacs [2,3]. There is a great variance in the amount and degree of organ sharing ranging from the MCOT type (minimal conjoined omphalopagus twinning) to complex sharing of the liver, biliary system and intestinal tract [4,5]. Issues are faced by the care team in each phase of care including initial postnatal stabilization, determining the extent of preoperative testing, managing the clinical course and unique physiology of each twin, timing of surgical separation, the separation operation and postoperative care. We successfully managed each of these phases and here report the first case of biliary sharing complicated by an infected choledochal cyst. This adds to several previously reported cases of conjoined twins with complex biliary anatomy and provides the care team with important considerations in management of these twins.Graphical abstract
Source: Journal of Pediatric Surgery Case Reports - Category: Surgery Source Type: research