A case of partial twining
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case of partial twining with ruptured giant omphalocele
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A case of partial twining
- 1. Dr Muhammad Javaid Iqbal PGR Paediatric Surgery Services Hospital, Lahore
- 2. Biodata Name: Age: Sex: Referred from: Mode of admission: Date of admission: Master A 2 days Male Okara Nursery May 2012
- 7. Presenting Complaints Gut outside abdomen Baby born with extra limbs
- 8. Baby born by SVD Gut outside the abdomen with ruptured membrane Extra limbs attached to torso No history of fetal distress or delayed cry History of presenting complaints
- 9. No history of Smoking Drug abuse Anticonvulsant use Diabetes or hypertension Maternal History
- 10. No history of Congenital anomalies Twinning Family History
- 11. Examination A baby of 3 kg, lying in the bed having vitals Heart Rate : Respiratory Rate: Temperature: Pallor : Jaundice : 148 beats/minute 36 breaths/minute 36°C Negative Negative
- 16. Defect in anterior abdominal wall in midline,15x 10cm in size Ruptured membrane visible with most of the gut and liver protruding through the defect Four extra limbs and a small trunk, attached to epigastric area with a broad stalk Fused lower limbs having hypoplastic empty scrotum Rest of abdominal examination un-remarkable Local Examination
- 17. Scrotum well developed. Testes palpable in upper scrotum. Cont’d
- 18. Partial twinning with ruptured giant omphalocele Diagnosis
- 19. Baseline: Normal Ultrasound Abdomen: Unremarkable . Echocardiography: Normal. Investigations
- 20. Moist dressing Temperature regulation Intravenous fluids and antibiotics started Blood arranged Operated on 4th day of life Management
- 21. Ruptured membrane with most of gut and liver lying outside the abdominal cavity Four limbs attached to torso Second set of gastrointestinal Tract was also present,which was excised Operative Findings
- 36.
- 48. Regular follow up 4 monthly Growth of baby Volume of abdominal cavity Follow up
- 49. The incidence of asymmetric twinning is extremely rare. About 1 per 1-2 million births. Most common presentation is omphalopagus joined either at hypogastric or suprapubic region. Epigastric attachement is sparse,only 45 cases reported to date. Literature Review
- 50. A few cases of incomplete twinning with omphalocele are reported,but only 1 case reported with giant omphalocele. No case reported with ruptured giant omphalocele. In our case we had the challenge of working out the puzzle of parasitic heteropagus,attached to the epigastric region with ruptured giant omphalocele. Cont’d
- 51. Save as much of structures as you can Take home message
- 52. Thanks Have a nice day