Xiufang Zhi1,2, Bo Hu3, Xuwen Zhao3, Jing Chen4, Chunyu Gu1,2, Linjie Pu1,2, Yulian Fang2,5,6, Chunquan Cai7,8,9,10. 1. Graduate College of Tianjin Medical University, Tianjin, 300070, China. 2. Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China. 3. Department of Neonatal Surgery, Tianjin Children's Hospital, Tianjin, 300134, China. 4. Department of Radiology, Tianjin Children's Hospital, Tianjin, 300134, China. 5. Tianjin Pediatric Research Institute, Tianjin, 300134, China. 6. Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China. 7. Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, 300134, China. cqcns6@126.com. 8. Tianjin Pediatric Research Institute, Tianjin, 300134, China. cqcns6@126.com. 9. Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China. cqcns6@126.com. 10. Department of Neurosurgery, Tianjin Children's Hospital, No. 238 Longyan Road, Beichen District, Tianjin, 300134, China. cqcns6@126.com.
Abstract
PURPOSE: Asymmetric conjoined twining (ACT) is a form of conjoined twining which is a rare malformation of monochorionic monoamniotic twin pregnancy. Most publications were single case reports. We reported a cohort of five cases with ACT from a single tertiary medical center and reviewed the case reports of ACT over the last decade to enrich the clinical research of this disease and summarized the clinical features of the disease. METHODS: We reviewed five cases of ACT admitted in Tianjin Children's Hospital from 17 March, 2008, through 7 March 2017. The cohort was analysed from general information, imaging manifestations, separation surgery, histopathological findings, outcome and follow-up. We searched the English literatures on case reports of ACT over the past decade from the PubMed database and presented details about the clinical characteristics, treatment, and prognosis of all cases. RESULTS: There were four males and one female in our cohort. Among the five cases, two parasites were located in epigastrium, two in rachis, and one in retroperitoneum (fetus in fetu, FIF). All of the parasites were separated successfully by operation in five cases and were confirmed to be ACT by histopathology reports. Four patients made an uneventful recovery except for one case of wound infection. All of them were doing well in follow-up. In the literature review, we found 41 cases of exoparasitic heteropagus twining (EHT) and 63 cases of FIF. CONCLUSIONS: ACT is very rare and usually diagnosed by prenatal ultrasonography (US). Computed tomography (CT) and magnetic resonance imaging (MRI) examinations are essential imaging examinations before separation surgery to delineate the anatomical relationship between the autosite and the parasite. In general, the separation surgery of ACT is less complicated and the prognosis is better compared with the symmetric conjoined twining (SCT).
PURPOSE: Asymmetric conjoined twining (ACT) is a form of conjoined twining which is a rare malformation of monochorionic monoamniotic twin pregnancy. Most publications were single case reports. We reported a cohort of five cases with ACT from a single tertiary medical center and reviewed the case reports of ACT over the last decade to enrich the clinical research of this disease and summarized the clinical features of the disease. METHODS: We reviewed five cases of ACT admitted in Tianjin Children's Hospital from 17 March, 2008, through 7 March 2017. The cohort was analysed from general information, imaging manifestations, separation surgery, histopathological findings, outcome and follow-up. We searched the English literatures on case reports of ACT over the past decade from the PubMed database and presented details about the clinical characteristics, treatment, and prognosis of all cases. RESULTS: There were four males and one female in our cohort. Among the five cases, two parasites were located in epigastrium, two in rachis, and one in retroperitoneum (fetus in fetu, FIF). All of the parasites were separated successfully by operation in five cases and were confirmed to be ACT by histopathology reports. Four patients made an uneventful recovery except for one case of wound infection. All of them were doing well in follow-up. In the literature review, we found 41 cases of exoparasitic heteropagus twining (EHT) and 63 cases of FIF. CONCLUSIONS: ACT is very rare and usually diagnosed by prenatal ultrasonography (US). Computed tomography (CT) and magnetic resonance imaging (MRI) examinations are essential imaging examinations before separation surgery to delineate the anatomical relationship between the autosite and the parasite. In general, the separation surgery of ACT is less complicated and the prognosis is better compared with the symmetric conjoined twining (SCT).
Authors: Maria Okumura; Adolfo Wenjaw Liao; Maria de Lourdes Brizot; Marcelo Zugaib; Regina Schultz Journal: J Ultrasound Med Date: 2011-02 Impact factor: 2.153