The Dominican Republic conjoined twins: Ischiopagus, tetrapus, omphalopagus

Alta and Clara, the Dominican Republic conjoined twins (ischiopagus, omphalopagus, tetrapus) were evaluated prior to separation with plain films, vaginograms, arteriograms, intravenous pyelogram, barium enema, and upper gastrointestinal series with small bowel follow-through. The clear demonstration of their internal anatomy allowed the surgeons to plan the operative approach and to make a reasonable judgment regarding viability of each baby. Each twin had a semicircular pelvis which joined the other to form a complete ring. There were a few hepatic arterial twigs from Alta which crossed the midline, proving at surgery to be a small bridge of tissue connecting the two livers. Clara's superior mesenteric arteries supplied the majority of the small bowel. Portal venous drainage was separate for each twin. Each baby had two kidneys in normal position with the bladders laterally placed. Each bladder received one ureter from each twin. Two separate small bowels joined proximal to the single colon which terminated in an anus related to Clara's pelvic structures. Following separation, each baby did well. Their postoperative anatomy is described.