# Unique Case of Epigastric Heteropagus Twins: A Surgical Challenge

## TL;DR

This paper describes a rare case of a 47-year-old woman with a parasitic twin attached to her epigastrium, highlighting the surgical challenges involved in its removal.

## Contribution

The paper presents a unique clinical case of epigastric heteropagus twins with detailed diagnostic and surgical considerations.

## Key findings

- A 47-year-old woman had a large abdominal mass with features of a primitive face and limb buds.
- Imaging revealed a vascular connection between the mass and the host’s epigastric artery.
- Surgical removal required careful pre-operative assessment to avoid hemodynamic compromise.

## Abstract

Parasitic twins are an extremely rare condition, though their precise occurrence is unclear, with estimates suggesting a few reported cases. The parasite, the dependent, undeveloped twin, is attached to the independent, developed twin, called the autosite, at many sites. There are eight probable sites for attachment: the thoracopagus, omphalopagus, craniopagus, cephalopagus, parapagus, ischiopagus, pyopagus, and rachipagus. We report a very rare case of epigastric heteropagus in which the host’s epigastrium was attached to the parasite.

A 47-year-old woman presented with a progressive abdominal mass that had been present since birth. She had four alive children who were all delivered vaginally at home. The patient was found to be pale throughout general, physical, and systemic tests, with the remainder of her data being within normal ranges. Upon abdominal examination, a pedunculated enlargement measuring approximately 24 × 16 × 12 cm and exhibiting signs of a primitive face with a single ear, a nose, and limb buds was discovered. Contrast-enhanced computed tomography (CT) and CT angiography revealed a soft tissue swelling covering the patient’s anterior thorax and abdomen, measuring 6.7 × 13 × 7.5 cm in size. The patient’s right superior epigastric artery served as the primary vascular supply for the lesion.

A parasitic epigastric heteropagus twin is a rare congenital anomaly. In such cases, it is imperative to pre-operatively assess shared organs and the feeding arterial supply in order to excise the mass in toto without compromising the hemodynamics of the host.