Conjoined Twins

1
Conjoined Twins

• Ashley Weingartner
• Megan Kuehn
• Justine Friedrich

2
What are Conjoined Twins?

• Conjoined twins are identical twins that have not
  split properly after fertilization, they share a
  body and may share vital organs.
• Identical twins are created from a single
  fertilized egg.
• If the egg does not separate within 12 days, it
  will not split completely.

• Instead of creating two separate embryos, the two
  embryos will remain attached, causing the babies
  to grow into one another.

3
Caring for Conjoined Twins

• Caring for conjoined twins can be very
  challenging.
• Conjoined twins that do survive often have
  serious physical challenges.
• May be unable to move on their own, eat on their
  own, or control their own brain or heart
  function.
• One twin usually relies on the other for
  nutrition, blood, and brain support.

4
History of Conjoined Twins

• Conjoined twins have fascinated people for
  centuries.
• They have been worshipped as gods and feared as
  monsters.
• They play a role in our myths and are a part of
  circus sideshows.

5
History of Conjoined Twins

• A popular term for conjoined twins is Siamese
  twins
• The term comes from Eng and Chang Bunker who were
  famous conjoined twins born in Siam in 1811.
• The term Siamese twins is no longer considered
  appropriate because they arent limited to any
  racial or ethnic group.

6
Are Conjoined Twins Common?

• Conjoined twins are not a common occurrence.
• Only about one set of conjoined twins are born
  every 400,000 births, but only once in every
  200,000 LIVE births.

• Are more likely to occur in India or Africa than
  in China or the United States.
• Conjoined twins are more often female than male,
  at a ratio of 31 or 70.

7
Statistics

• Approximately 40-60 arrive stillborn
• About 35 only survive one day
• Overall survival rate is between 5 and 25

8
Types of Conjoined Twins

• The classification of conjoined twins is
  determined by how the twins are joined.
• There has been as many as three dozen separate
  types of conjoined twins in the last century.
• All the names for conjoined twins end in
  -pagos. Which means fixed in Greek.

9

• Conjunctions Not Involving the Heart or Umbilicus
• Craniopagus about 2 of conjoined twins
• Joined at the skull, can share portions of the
  brain and blood circulation.
• -Vertical Craniopagus joined at the top of the
  head at a 180-degree angle to each other.
• -Occipital Craniopagus joined at the back of
  the head.
• -Frontal Craniopagus joined at the forehead.
• -Parietal Craniopagus joined at the side of the
  head.

10

• A skull of craniopagus conjoined twins
• Pygopagus conjoined twins

11

• Pygopagus about 19 of conjoined twins
• Also called illeopagus.
• Joined at the pelvis and lower spine.
• Each twin has a separate heart.
• Most male twins are still born, almost all
  pygopagus twins are female.
• Many conjoined twins that survive to adulthood
  have been pygopagus.
• Separation is usually successful, complications
  have been seen when the spinal chord is involved.

12

• Midline Conjunctions
• Thoracopagus about 35 of all conjoined twins,
  the most common.
• Joined at the upper chest from clavicle to
  sternum.
• Can share a heart or a pericardium.
• Separation is extremely risky, both twins often
  die.
• Parapagus 5 of conjoined twins
• Also called diprosopus
• Joined side by side at the torso, usually share
  three legs, but have separate heads and arms.

13

• Thoracopagus conjoined twins.
• Twins joined side by side called parapagus twins.

14

• Cephalopagus extremely rare
• Also called syncephalus or janiceps.
• Conjoined heads and necks, sometimes they share a
  heart.
• Most are stillborn, those that arent die shortly
  after birth.
• Omphalopagus 30 of all conjoined twins
• Joined at the abdomen, from sternum to the groin.
• Often share liver, and parts of digestive system.

15

• Cephalopagus twins are joined at the head and
  neck.
• Chang and Eng Bunker, known as the original
  Siamese twins were omphalopagus twins.

16

• Ischopagus 6 of conjoined twins
• Joined at the front pelvis and lower spine, with
  spines at 180-degree angles of each other.
• About 70 of ischopagus twins have four legs in
  the cases of three legs the third leg is shared
  between the twins, but not controlled by either.
• Ischio-omphalopagus
• Combination of ischiopagus and omphalopagus
  twins.
• Usually have a Y shape with three legs and a
  single set of genitalia.

17

• Ischopagus twins joined at front pelvis and lower
  spine
• Ischio-omphalopagus conjoined twins

18

• Rare Forms of Conjoined Twins
• Parasitic twins
• Asymmetrical twins with a smaller twin, being
  less developed and dependent on the other twin.
• Can occur with any type of conjoined twins.
• Fetus in Fetu
• A situation in which a fetus is contained
  completely within the body of its sibling.

19

• Manars parasitic twin, Islaam, died after an
  extensive surgery.
• This is a child with its sibling developing
  inside of it.

20
Separation

• Separation of conjoined twins is usually
  performed at a very young age.
• In some cases the brain or the heart must be
  separated in order to provide each twin with
  vital organs.
• To date, about 200 separations have been
  performed.

21
When to Separate

• In the past, surgery was delayed until twins were
  6-12 months old so that they could become
  stronger.
• Since there are now life-support systems and
  diagnostic tools are more sophisticated, earlier
  separation is more common.
• Immediate separation is needed when one twin is
  stillborn.
• Separation while twins are too young to realize
  that they are joined is thought to help their
  psychological recovery.

22
New Developments in Surgery

• Since the 1970s, chances of survival have
  improved dramatically.
• Surgeons now routinely separate livers, and have
  developed ways to cover large wounds with skin
  and reduce the risk of infection.
• Although success rates have improved over the
  years, surgical separation is still rare.

23
To separate or not

• Is surgery viable?
• Doctors conduct tests such as an ultrasound, MRI
  (magnetic resonance imaging) and 3D graphics to
  determine
• The location and extent of the join
• and whether internal organs are involved
• The medical team and their experience is also a
  factor

24
To separate or not

• Is surgery viable? (cont)
• If surgery is safe, the effects to both twins
  must be taken into factor.
• Are both twins equally robust?
• What are the chances of one or both surviving
  surgery?
• What quality of life is likely for one or both
  twins after surgery?
• How does this compare with the probable quality
  of life if the twins remain joined?

25
To separate or not

• Ethical Questions
• Is it right to sacrifice one twin to save the
  other?
• Is it reasonable to invest scarce resources in
  uncertain operations?

26
To separate or not

• Religious considerations
• Parents knowing that one twin will die as a
  result of the surgery will object on religious
  grounds, in which case, a judge may overrule the
  parents decision
• Parents who know that both twins have an equal
  chance at survival will agree to the surgery and
  declare that the outcome was a will of God.

27
To separate or not

• Cultural Influences
• Where they live
• Conjoined twins in Soviet Russia were treated as
  outcasts
• If left unseparated in Africa they could be seen
  as outcasts and curiosities
• Attitudes towards disability
• Some parents cant stand seeing disability in
  their children and do the surgery to avoid it
  even if it means they could lose one
• Some parents believe that their children are
  better off and more able bodied when they are
  stuck together than when they are apart

28
To separate or not

• What do twins think about being separated?
• Some are content and have adjusted to the
  psychological and physiological aspects of life
  conjoined
• A set of twins separated at age twenty-nine were
  very determined to be separated
• Ones separated at infancy have no recollection of
  being conjoined, may actually be glad to have
  independent lives

29
Cases of Conjoined twins

• Masha and Dasha Krivoshlyapova
• Born in 1950 in Moscow
• Taken way from mother at birth
• They had a third leg that was amputated at age 10
• They were incarcerated until age 40 in Soviet
  institutions that were degrading
• They were tested for responses with pins and
  razors
• They are now both alcoholics and shunned by the
  society they live in

30
Cases of Conjoined twins

• Lori and Reba Schappell
• Born in 1961 in Pennsylvania
• The only pair of unseparated
• twins alive today that are joined
• at the head
• Reba is shorter and must sit
• on a wheeled stool
• They dont want to be separated
• They were institutionalized when
• they were children

31
Cases of Conjoined twins

• Anna and Barbara Rozycki
• Born in 1970 in the United Kingdom
• Joined at the breastbone and liver
• Mother almost died during birth and the twins
  were separated immediately so the mother never
  saw them as one
• Neither one has a physical disability

32
Cases of Conjoined twins

• Laleh and Laden Bijani
• Born January 17, 1974 in Firouzabad, Iran
• Joined at the head
• Separated in July 2003
• They had a 5050 chance of
• survival
• Laden died an hour after
• separation
• Laleh died 90 minutes after Laden

33
Cases of Conjoined twins

• Elisa and Lisa Hansen
• Born in 1978 in the United States
• First successful brain separation
• The separation occurred when they were 19 months
  old
• Lisa has significant brain damage and has to use
  a wheelchair
• Both are now doing fine and live near Salt Lake
  City, Utah

34
Cases of Conjoined twins

• Abigail and Brittany Hensel
• Born in 1990 in the Midwest of the United States
• Parents are opposed to separation because it
  would cause severe disabilities and the girls
  would have to give up their favorite activities

35
Cases of Conjoined twins

• Amy and Angela Lakeberg
• Born in 1993 in the city of Chicago
• Had a joined heart and liver
• Amy died during separation
• Angela died 10 months later of pneumonia
• Their case raised some of the many issues
  involved in separation of conjoined twins

36
Cases of Conjoined twins

• Esther and Stella Alponce
• Born in 1999 in Tanzania
• Joined at the spine
• They were separated in Cape Town
• There was risk of paralysis in one or both of the
  girls
• They both were able to move their legs within
  hours of operation
• They returned to their village 11 months after
  the operation
• Both were happy, healthy and learning to walk

37
Cases of Conjoined twins

• Gracie Jodie and Rosie Mary Attard
• Born in 2000 in Manchester UK
• Joined at the lower abdomen and spine
• If left unseparated both would have died
• Parents opposed separation because of their Roman
  Catholic religion court opposed
• Rosie died
• Gracie has made good progress and should lead a
  normal life

38
Cases of Conjoined twins

• Manar Maged
• Born in March 2004 in Aghur, Egypt
• The underdeveloped twin had a brain but no body
• A 13 hour surgery was performed
• The family named the twin that didnt survive
  Islaam
• Manar died in March 2006, of a severe brain
  infection 13 months following surgery

39
Cases of Conjoined twins

• Abigail and Isabelle Carlson
• Separated in Summer of 2006
• From North Dakota
• Separated at the Mayo Clinic in Rochester, MN
• http//www.youtube.com/watch?vr08wJnNmUz0

40
Questions?