International Journal of Recent Advances in Multidisciplinary Topics Volume 5, Issue 10, October 2024 https://www.ijramt.com | ISSN (Online): 2582-7839 *Corresponding author: umaminu13@gmail.com 7 Abstract: Background: Conjoined twins are babies attached to each other at some point. They occur in 1 in about every 200,000 live births and may be described as Symmetric (Diplopagus) or Asymmetric (Heteropagus). Heteropagus refers to conjoined twins where an apparently normal twin- the autosite- has attached to it an incomplete member- the parasite- and are exceedingly rare with a worldwide incidence of about 1 in 1-2 million births. The form of these heteropagus twins in which the parasite is attached to the epigastric region of the host referred to as epigastricheteropagus is even rarer. Case report: Here we report a day-old female neonate delivered by Spontaneous Vertex Delivery in a Primary Health Centre to a 20year old P3+0 3A with a parasite attached at the epigastric region. The parasite comprised a trunk to which two identifiable lower limbs were attached, with a single stalk attached to its upper pole from which two hands with identifiable digits arose. There was also a coexisting omphalocoele in an otherwise normal autosite. Abdominal USS and CT scan showed a single liver with no major connection between the babies, Intravenous Urogram confirmed the presence of two kidneys normal in position and excretion with normal collecting system within the autosite and none in the parasite. Doppler USS of the stalk eliminated major vascular connection between the two. Separation was successfully done at 2 months of life and patient did well postoperatively. Child is currently five (5) years old and growth and development proceeding normally. Conclusion: Epigastric heteropagus twins require multidisciplinary approach; careful planning and separation plan individualized according to the need of emergent separation and degree of organ fusion. Keywords: heteropagus, conjoint, twins, separation, child. 1. Introduction Since prehistoric times conjoined twins have continued to fascinate mankind. The first report of this rare aberration of human reproduction was by Ambrose Piere in the 16 th century [1]. With a worldwide incidence of 1 in every 50,000 to 100,0000 births [2], the term conjoined twins refer to babies who are joined at some point, and areeither Symmetric (Diplopagus) or Asymmetric (Heteropagus) [2]-[4]. Heteroghagus a term derived from the Greek words ‘pagus’ which means ‘that which is fixed’ refers to a rare form of conjoined twin in which twins are asymmetrically attached with 1 twin the auto site nearly normal anatomically while the parasite is attached in a non-duplicate fashion to any part of the body or even within the autosite [2]-[4]. The former may be referred to as exoparasiticheteropagus twin and the latter endoparasitic heteropagus [1]. Endoparasiticheteropagus in which the parasite is attached to the epigastric region of the autosite is called epigastricheteropagusand occurs rarely amongst the 1 in 500,000-2million live births that are heteropagus conjoined twin [3], [6], [7] with only 71 cases reported in English literature worldwide from 1946 to 2015 [8] The major challenge to the management of this anomaly is occasioned by its rarity and thus low individual surgeon exposure coupled with the fact that Epigastric Heteropagus twins may present with more complex manifestation than typical conjoined twins. We present here a case of epigastricheteropagus conjoined twin admitted on the first day of life, who was successfully managed. 2. Case Report A 1-day-old, full-term female born to a 20-year-old P3+0 3A via SVD at a Primary health facility after a prolonged labor. No previous history of twining in mother, no family history of same. No history of assisted reproductive techniques. Pregnancy was booked with 3 visits but no antenatal ultrasound scan done. No history of cigarette smoking or ingestion of alcohol or un-prescribed medication. Father is 30yrs old peasant farmer. Baby is able to feed well and pass stool and urine. Examination revealed an autosite that was active and pink, moving all limbs actively with no features of dysmorphism. Combined weight was 3.1kg.S ystemic examination was normal except for a co-existing omphalocoele major with an intact covering. Parasite was attached to the epigastric region of the autosite and comprised two lower limbs and a single stalk on its upper pole giving rise to two hands with digits. There were well developed hip joint and knee joint with is also flexion Epigastric Heteropagus Conjoined Twin – A Case Report Aminu Muhammed Umar 1* , Kefas John Bwala 2 , Makama Baje Salihu 3 , Aminu Muhammed 4 , Stephen Yusuf 5 1,2 Consultant Paediatric Surgeon, Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria 3 Consultant Urologists, Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria 4 Professor/Consultant Paediatric Surgeon, Department of Surgery, Aminu Kano University Teaching Hospital/Bayero University, Kano, Kano State, Nigeria 5 Senior Registrar, Department of Orthopaedic Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria