Conjoined Twins

Ashley Weingartner
Megan Kuehn
Justine Friedrich

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.

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.

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.

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.

Are Conjoined Twins Common?

Conjoined twins are
Are more likely to
not a common
occur in India or
occurrence.
Africa than in China
or the United States.
Only about one set of
Conjoined twins are
conjoined twins are
born every 400,000
more often female
births, but only once
than male, at a ratio
in every 200,000 LIVE
of 3:1 or 70%.
births.

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

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.

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.

 A skull of craniopagus
conjoined twins

Pygopagus conjoined
twins

 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.

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.

 Thoracopagus
conjoined twins.

Twins joined side by

side called parapagus
twins.

 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.

 Cephalopagus twins
are joined at the head
and neck.

Chang and Eng

Bunker, known as the
original Siamese
twins were
omphalopagus twins.

 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.

 Ischopagus twins
joined at front pelvis
and lower spine

Ischio-omphalopagus
conjoined twins

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.

 Manars parasitic
twin, Islaam, died
after an extensive
surgery.

This is a child with its

sibling developing
inside of it.

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.

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.

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.

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

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?

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?

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.

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

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

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

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

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

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 50:50 chance of
survival
Laden died an hour after
separation
Laleh died 90 minutes after Laden

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

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

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

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

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

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

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?
v=r08wJnNmUz0

Questions?