Conjoined twins

Source: Wikipedia, the free encyclopedia.
"Siamese twins" redirects here. For other uses, see Siamese twins (disambiguation).

Conjoined twins
Other namesSiamese twins, monstra duplicia
X-ray of conjoined twins, Cephalothoracopagus.
SpecialtyMedical genetics Edit this on Wikidata
SymptomsBodies fused
ComplicationsDepends on type
Usual onsetBeginning of pregnancy
DurationLifelong
Typessee article
CausesIncomplete fission
TreatmentSurgery, symptomatic care
PrognosisDepends on type; occasionally may survive

Conjoined twins, popularly referred to as Siamese twins,

Southwest Asia and Africa.[5] Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.[5][6]

Two possible explanations of the cause of conjoined twins have been proposed. The one that is generally accepted is fission, in which the fertilized egg splits partially.

monozygotic but non-conjoined twins.[8]

Chang and Eng Bunker (1811–1874) were brothers born in Siam (now Thailand) who traveled widely for many years and were known internationally as the Siamese Twins. Chang and Eng were joined at the torso by a band of flesh and cartilage, and by their fused livers. In modern times, they could easily have been separated.[9] Due to the brothers' fame and the rarity of the condition, the term Siamese twins came to be associated with conjoined twins.

Causes

There are two hypotheses about the development of conjoined twins.

  1. a single fertilized egg does not fully split during the process of forming identical twins. If the zygote division occurs after two weeks of the development of the
    embryonic disc, it results in the formation of conjoined twins.[10]
  2. fusion of two fertilized eggs occurs earlier in development.

Partial splitting of the

BMP4 and contributes to regulation of head development. Over- or underexpression of this gene in laboratory animals results in severe malformations of the head region, including duplications, similar to some types of conjoined twins.[12]

Types

Conjoined twins are typically classified by the point at which their bodies are joined. The most common types of conjoined twins are:

Other, less common types of conjoined twins include:

Treatment

Separation

Surgery to separate conjoined twins may range from very easy to very difficult depending on the point of attachment and the internal parts that are shared. [18] Most cases of separation are extremely risky and life-threatening. Though there have been a number of successful separations throughout history, in many cases, the surgery results in the death of one or both of the twins, particularly if they are joined at the head or share a vital organ. This makes the ethics of surgical separation, where the twins can survive if not separated, contentious. Alice Dreger of Northwestern University found the quality of life of twins who remain conjoined to be higher than is commonly supposed.[19] Lori and George Schappell and Abby and Brittany Hensel are notable examples.

The first recorded separation of conjoined twins took place in the Byzantine Empire in the 900s. One of the conjoined twins had already died, so the doctors of the town attempted to separate the dead twin from the surviving twin. The result was briefly successful, as the remaining twin lived for three days after separation. The next recorded case of separating conjoined twins was several centuries later, in Germany, in 1689.[20][21] The first recorded successful separation of conjoined twins was performed in 1689 by Johannes Fatio.[22] Around this same time Dr. Böhm of Gunzenhausen separated his own children, a pair of omphalopagus or xiphopagus twins; the feebler twin died four days later, but the healthier one was still alive and well at age five, when the case was reported.[23] In 1955, neurosurgeon Harold Voris (1902-1980)[24] and his team at Mercy Hospital in Chicago performed the first successful operation to separate craniopagus twins (conjoined at the head), which resulted in long-term survival for both.[25][26][27] The larger girl was reported in 1963 as developing normally, but the smaller girl was permanently impaired.[28]

In 1957, Bertram Katz and his surgical team made international medical history performing the world's first successful separation of conjoined twins sharing a vital organ.[29] Omphalopagus twins John Nelson and James Edward Freeman (Johnny and Jimmy) were born in Youngstown, Ohio, on April 27, 1956. The boys shared a liver but had separate hearts and were successfully separated at North Side Hospital in Youngstown, Ohio, by Bertram Katz. The operation was funded by the Ohio Crippled Children's Service Society.[30]

Recent successful separations of conjoined twins include that of the separation of

Kathmandu, Nepal, in 2000. The 97-hour surgery on the pair of craniopagus twins was a landmark one which took place in Singapore; the team was led by neurosurgeons Chumpon Chan and Keith Goh.[31] The surgery left Ganga with brain damage and Jamuna unable to walk. Seven years later, Ganga Shrestha died at the Model Hospital in Kathmandu in July 2009, at the age of eight, three days after being admitted for treatment of a severe chest infection.[32]

Infants Rose and Grace Attard, conjoined twins from Malta, were separated in the United Kingdom by court order Re A over the religious objections of their parents, Michaelangelo and Rina Attard. The twins were attached at the lower abdomen and spine. The surgery took place in November 2000, at St Mary's Hospital in Manchester. The operation was controversial because Rose, the weaker twin, would die as a result of the procedure as her heart and lungs were dependent upon Grace's. However, if the operation had not taken place, it was certain that both twins would die.[33][34] Grace survived to enjoy a normal childhood.[35]

In 2003, two 29-year-old women from Iran, Ladan and Laleh Bijani, who were joined at the head but had separate brains (craniopagus) were surgically separated in Singapore, despite surgeons' warnings that the operation could be fatal to one or both. Their complex case was accepted only because technologically advanced graphical imagery and modeling would allow the medical team to plan the risky surgery. However, an undetected major vein hidden from the scans was discovered during the operation.[36] The separation was completed but both women died while still in surgery.

In 2019 Safa and Marwa Ullah were separated at Great Ormond Street Hospital in London, England. The twins, born January 2017 were joined at the top of the head with separate brains and a cylindrical shared skull with the twins each facing in opposite directions to one another. The surgery was jointly led by neurosurgeon Owase Jeelani and plastic surgeon Professor David Dunaway. The surgery presented particular difficulties due to a number of shared veins and a distortion in the shape of the girls' brains, causing them to overlap. The distortion would need to be corrected in order for the separation to go ahead. The surgery utilized a team of more than 100 including bio engineers, 3D modelers and a virtual reality designer. The separation was completed in February 2019 following a total of 52 hours of surgery over three separate operations. As of July 2019, both girls remain healthy and the family planned to return to their home in Pakistan in 2020.[37][38]

History

Conjoined brothers from Nuremberg Chronicle (1493)
Conjoined twin sisters from Nuremberg Chronicle (1493)
Moche ceramics depicting conjoined twins. 300 CE Larco Museum Collection Lima, Peru

The

City of God, refers to a man "double in his upper, but single in his lower half—having two heads, two chests, four hands, but one body and two feet like an ordinary man."[40]

According to Theophanes the Confessor, a Byzantine historian of the 9th century, around 385/386 AD, he writes that "in the village of Emmaus in Palestine, a child was born perfectly normal below the navel but divided above it, so that it had two chests and two heads, each possessing the senses. One would eat and drink but the other did not eat; one would sleep but the other stayed awake. There were times when they played with each other, when both cried and hit each other. They lived for a little over two years. One died while the other lived for another four days and it, too, died."[41]

In Arabia, the twin brothers

Abū al-Rayhān al-Bīrūnī described conjoined twins in his book Kitab-al-Saidana.[43]

The English twin sisters

dicephalus type, essentially two heads sharing the same body (1460–1488, although the dates vary); the pygopagus Helen and Judith of Szőny, Hungary (1701–1723), who enjoyed a brief career in music before being sent to live in a convent; and Rita and Cristina of Parodi of Sardinia
, born in 1829. Rita and Cristina were dicephalus tetrabrachius (one body with four arms) twins and although they died at only eight months of age, they gained much attention as a curiosity when their parents exhibited them in Paris.

kidnapped by a rival showman. The kidnapper fled to England but was thwarted because England had already banned slavery. Smith traveled to England to collect the girls and brought with him their mother, Monimia, from whom they had been separated. He and his wife provided the twins with an education and taught them to speak five languages, play music, and sing. For the rest of the century, the twins enjoyed a successful career as "The Two-Headed Nightingale" and appeared with the Barnum Circus. In 1912, they died of tuberculosis
, 17 hours apart.

Giacomo and Giovanni Tocci, from Locana, Italy, were immortalized in Mark Twain's short story "Those Extraordinary Twins" as fictitious twins Angelo and Luigi. The Toccis, born in 1877, were dicephalus tetrabrachius twins, having one body with two legs, two heads, and four arms. From birth they were forced by their parents to perform and never learned to walk, as each twin controlled one leg (in modern times, physical therapy allows twins like the Toccis to learn to walk on their own). They are said to have disliked show business. In 1886, after touring the United States, the twins returned to Europe with their family. They are believed to have died around this time, though some sources claim they survived until 1940, living in seclusion in Italy.

Notable people

Born 19th century and earlier

Chang and Eng Bunker, watercolor on ivory, 1835 or 1836
  • Mary and Eliza Chulkhurst, alleged names of the Biddenden Maids (per tradition, born in the 12th century) of Kent, England.[44] They are the earliest set of conjoined twins whose names are (purportedly) known.
  • Lazarus and Joannes Baptista Colloredo (1617 — after 1646), autosite-and-parasite pair
  • pygopagus
    .
  • Siam (now Thailand), and the expression Siamese twins is derived from their case. They were joined by the areas around their xiphoid cartilages
    , but over time, the connective tissue stretched.
  • In 1834, a set of conjoined triplets were born in Catania. Two of the heads shared a neck while the other head had its own. The infant, a male, was described by Galvagni.[45]
  • pygopagus
    ). The McCoy twins were born into slavery in Columbus County, North Carolina, United States. They went by the stage names "The Two-Headed Nightingale" and "The Eighth Wonder of the World" and had an extensive career before retiring to the farm on which they were born.
  • dicephalus
    tetrabrachius dipus)
  • Josefa and Rosa Blazek (January 20, 1878 — March 30, 1922),
    pygopagus.[47] The Blazek twins were born in Skrejšov, Bohemia (now the Czech Republic).[47] They began performing in public exhibitions at the age of 13, and their act later included Rosa's son Franz. The sisters died in Chicago, Illinois.[48]

Born 20th century

Born 21st century

Conjoined twin lambs

In fiction

Conjoined twins have been the focus of several works of fiction, including:

See also

Notes

  1. ^ Conjoined twins are almost universally assumed to always be monozygotic, but dizygotic conjoined twins are theoretically possible.[3][4]

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