Thoraco-omphalopagus Conjoined Twins with a Clinic Suspicion of a Shared Renal System: A Case Report

Objectives We report a case of conjoined twins with suspicion of sharing the same renal system.

Methods Case report

Results Conjoined twins have a female predominance and their estimated prevalence in the literature varies widely, from 1:50.000 to 1:200.000. The twins are monozygotic, monoamniotic, and monochorionic. They are classified according to the most prominent site of connection. Anomalies commonly associated to conjoined twins includes cardiac defects, abnormal pulmonary and hepatic venous drainage, renal dysplasia and double collecting system. The most common type of renal fusion anomaly is the horseshoe kidney. Further investigation of the urinary tract includes ultrasonography, isotope renography, micturating cysto-urethrography and cystoscopy. A 4 months year-old conjoined female twins, joined at the chest and abdomen, a condition called thoraco-omphalopagus, came to the department with the clinic suspicion of sharing the same renal system. They shared the liver, but there was a doubt that the renal system could also be connected. This information would be very important to understand all the anatomy between the two, discover eventual shunts and help plan the split surgery. We performed renal scans with DTPA-99mTc and DMSA-99mTc and injected MAA-99mTc, some with SPECT, which showed completely separated and functional renal systems between the two twins and the absence of vascular shunts. They went to surgery and are now fully separated, living well. The postnatal management of conjoined twins is determined by the effect of shared viscera on stability and long-term viability. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and associated abnormalities is important for surgical planning and prognostic information. We show a case with a clinical suspicion of renal system connection that was proven not to be true by renal scans. This information associated with the additional data provided by the study with MAA-99mTc had a major impact on the final outcome that in this case was a successful split surgery and a better quality of life for both the twins.

Conclusions The scintigraphic studies of both renal systems and evaluation of shunt helped guide the surgical approach of these young conjoined twins.