Conjoined twin at abdomen: twin A anencephaly and face presentation with twin B cephalic presentation: a case report and review of the literature

Abstract

Objectives: Conjoined twins are described as having been physically fused during pregnancy and delivery. They share some vital organs, such as the heart, lungs, liver, abdomen, etc. The article aims to present a unique discussion on conjoined twins at the abdomen, with twin A with anencephaly and face presentation and twin B with cephalic presentation. It is a conjoined twin fused at the abdomen. Twin A has anencephaly with lung and abdomen outside of the abdomen, with negative fetal heartbeat, and Twin B has cephalic presentation with a well-formed head and positive heartbeat. Conjoined twin is rarely diagnosed at delivery, but in resource-limited countries such as Ethiopia, it is diagnosed during delivery. It had a psychological impact both for pregnant women and the family. Therefore, appropriate counseling of pregnant women to have early ultrasound screening and follow-up is crucial. Case summary: We encountered a rare case of a conjoined twin pregnancy involving twin A with anencephaly and face presentation and twin B with cephalic presentation. The patient, a 19-year-old woman from rural Ethiopia, presented at Nekemte Specialized Hospital with pushing down pain and a gush of fluid per vagina for 10 hours. After admission, an obstetric ultrasound revealed a twin pregnancy with twin A presenting with anencephaly (face presentation) and a negative fetal heart rate, and twin B presenting with cephalic presentation and a positive fetal heart rate. The patient underwent a cesarean section, and the procedure resulted in one conjoined twin with anencephaly and the other well formed. After a week of recovery, the patient was discharged with counseling for future pregnancies. Conclusion: Conjoined twinning is a rare phenomenon, occurring in 1 in 50,000–100,000. It is rarely diagnosed during delivery. However, in resource-limited setups, it is diagnosed during delivery.