1. Case report
A 20-year old mother at week 39 of her gravida 1 underwent
a cesarean section. A natural delivery was not feasible due to
prenatally detected fetal anomalies interfering with vaginal
delivery. A male infant was born. At birth a giant omphalocele
(10 15 cm) and an extra trunk with lower extremities of the
parasitic heteropagus twin originating from the lower right part of
the thorax and epigastrium were observed. The newborn was
referred for further investigation and treatment to Vilnius university
children hospital. On admission day the status of the patient
was critical due to major congenital anomalies. As mentioned
previously, a giant exomphalos was present with no damage of the
peritoneal coverings. The liver and intestines were protruding into
the exomphalos sac. The parasite twin was attached to the thorax
under the level of the nipples: two lower well-formed limbs and an
upper left rudimental limb that was represented by an appendage
resembling forceps, hips, and underdeveloped external genitalia
were present. There was a total lack of movement in its extremities
(Fig. 1). Echocardiography has shown a transposition of the great
vessels, mitral atresia, common ventricle and pulmonary artery
hyperplasia. Abdominal sonography of the autosite has confirmed
that the liver and intestines protrude into the omphalocele sac.
Heteropagus sonography has demonstrated substantial part of the
truncus to be occupied by a large urinary bladder with thickened
not homogenous wall, full of cloudy content. A kidney and urinary
bladder were connected by a curvy ureter. A special study of the
parasite’s irrigation was performed. Computed tomography
angiography (CTA) scan delineated the anatomy of vascular communication
between both fetuses. A vascular pedicle measuring