Challenges In The Management Of Conjoined Twins In A Poor Resource Setting: A Report Of 3 Cases

Background: Despites the advances in transport, intensives care unit and new treatments modalities, conjoined twins continue to pose a significant challenge for paediatric surgeons. This study was undertaken to highlight the peculiarities of the management of conjoined twins in a poor resource setting. Methods: All confirmed cases of conjoined twins were prospectively documented from 2001 to date at the Charles De Gaulle Paediatric Teaching Hospital in Ouagadougou (Burkina Faso). Results: Three cases were recorded: one case of thoraco-omphalopagus conjoined twins, born prematurely by elective caesarean surgery and transferred at the second hour of life, one case of pygomelus conjoined twins with two phalluses, and one last case of epigastric heteropagus conjoined twins naturally delivered at home at term and transferred at 15 days and three months of age, respectively. All our patients were male. Antenatal diagnosis was made in one case. Associated malformations were found in two patients. Thoraco-omphalopagus twins who shared the breastbone, liver, heart, and transverse colon died at day 38 of life from heart failure before any treatment. The two others were successfully operated by surgical resection separation of the parasitic twin at 30 days of life for the epigastric heteropagus conjoined twins and four and a half months for pygomelus conjoined twins. Conclusion: The management of conjoined twins is difficult in the context of Sub-Saharan Africa developing countries. Their survival depends on an early detection by prenatal diagnosis, the creation of intensive care units, the inclusion of major congenital malformations in national neonatal programs for the integrated care of mother and child diseases and the development of partnership between hospitals in the South and those in the North.