Scintigraphy in assessment of the feasibility of separation of a set of xipho-omphalopagous conjoined twins

An account is given of the assessment of a set of xiphoomphalopagous twins by means of Tc-99m microcolloid human serum albumin (HSA) and Tc-99m HIDA scintigraphy before their successful separation. The Tc-99m HSA examination showed the absence of connections between the two hearts and major vessels, as well as the independent vascularization of each liver parenchyma and absence of substantial intrahepatic shunts. Tc-99m HIDA disclosed bile secretion and the existence of intra-hepatic ducts in both twins. In one, there was excretion into the intestine and the gallbladder and common bile duct were visualized, whereas in the other excretion was slow, either because of duct hypoplasia or as a result of the connections with the other twin. On separation, it was found that the liver parenchyma was composed of two fused parts (the livers of each twin). in one twin, cholangiography showed the gallbladder and intrahepatic and extrahepatic bile ducts with normal excretion into the intestine and excellent drainage, whereas in the other twin the gallbladder was absent, the common bile duct was hypoplastic, and excretion was poor. The two scintigraphic techniques employed provided evidence of bile duct function and enabled the separation to be planned, while intraoperative cholangiography gave a clear picture of the anatomical details before the reconstruction procedure.