The role of multidisciplinary team discussions in the management of thoraco-omphalopagus conjoined twins: A case report from a low-resource setting

Abstract

Introduction and importance

Conjoined twins represent a rare medical phenomenon that poses significant clinical and ethical challenges, particularly in resource-limited settings.

Case presentation

We present a case of conjoined twins delivered at 39 weeks gestation to a 27-year-old refugee mother. The delivery was by emergency cesarean section due to footling breech presentation. Initial assessments revealed shared cardiac anatomy, with Twin A exhibiting a more favorable anatomical structure compared to Twin B, who presented with severe cardiac malformations. Follow-up imaging, including CT angiography, uncovered additional complexities, such as dextrocardia and situs inversus in Twin A, raising further challenges regarding surgical separation.

Clinical discussion

Management required a multidisciplinary discussion involving social worker, nurses, pediatric surgeons, neonatologists, pharmacist, nutritionist, pediatric cardiac surgeons, radiologists, and anesthesiologists to address both clinical challenges and the ethical considerations surrounding separation in the context of one twin with unfavorable anatomy. The team emphasized tailored care and adjustment of medication dosages due to the shared circulatory system of the twins. Despite the team's efforts, both twins succumbed to heart failure.

Conclusion

This case highlights the clinical and ethical complexities of managing conjoined twins with shared vital organs in a low-resource setting. It underscores the importance of advanced imaging, multidisciplinary planning, and social support;- especially for vulnerable populations like refugees. Strengthening antenatal care, including routine obstetric ultrasound, is essential for early diagnosis, timely referral, and improved outcomes.