Ekatha Ann John TNN Dec 14, 2013
Rare Case Of Boys Joined At Buttocks; Only Four Pairs In Medical HistoryChennai: Doctors at a city hospital are preparing for a marathon surgery to separate nine-month-old twin boys from Tanzania, joined at the tail end of their spines.
Ericana and Eluidi were born facing away from each other with separate heads, necks, shoulders, arms, hearts and lungs but they shared an anus, urinary passage and a penis — a rare condition that is known as ‘pygopagus twins’.
The operation, scheduled to begin on December 16, is expected to last up to 16 hours. “Our goal is to create two functional children,” said Dr Venkat Sripathi, senior consultant paediatric urologist of Apollo Hospitals, who will be leading a team consisting of 20 specialists.
According to medical literature, pygopagus twins account for 17% of the conjoined twin population throughout the world.
Of the 30 sets of pygopagus twins reported across the world, 26 were female. While a few hospitals in India have successfully operated on female twins, no records exist on the separation of male twins.
Nine-month-old Tanzanian twins Ericana and Eluidi will soon be able to look each other in the eye if doctors have their way. The conjoined twins are joined at the posterior and share an anus, urinary passage and a penis.
Three months after they were born with a condition medical journals describe as ‘rare’, the twins’ 20-year-old mother boarded a flight from Tanzania to India, hoping she would return to her native village — a three-day drive from the capital of Dodoma — with her sons on either side of her.
“The twins were admitted to a hospital in Tanzania for three months. After a lot of discussion, doctors told the mother the separation of the babies was fraught with risk. Health officials from the country sought our help and we decided to take up the case,” said Dr Venkat Sripathi, senior consultant and paediatric urologist of Apollo Hospitals.
Doctors found that the babies were pygopagus twins — who account for 17% of all conjoined twins in the world — with the tail ends of their spines joined. “They have a single anus, urinary passage and rectum. Their penises are fused. It was unlike anything we had seen before,” said Dr Sripathi. When doctors at the hospital pored over similar cases across the world, they gauged the rarity of the condition — of the 30 sets of pygopagus twins reported across the world, 26 were female and only four were male.
“In India, a few hospitals have successfully separated female pygopagus twins, but we found practically nothing on separating males. Separating males is a lot more challenging as in females the vagina and urinary passage are often separate,” said Dr Sripathi. The surgery, scheduled for December 16, will be performed at Apollo Hospitals’ Vanagaram branch.
The surgery will take 14 to 16 hours and the team will comprise 20 senior specialists from neurosurgery, plastic surgery, paediatric surgery and paediatric urology. “The babies have undergone six procedures ahead of the sur gery. Over the last five months, we’ve also inserted tissue expanders in the back, buttocks and thighs so that skin flaps can be rotated to cover the large defects left after separation,” said plastic surgeon Dr Roshini Gopinathan at a press conference the hospital held ahead of the surgery.
The surgery, which will be live streamed for doctors who are interested in the case, will involve separating the spine, anus, rectum, penis and urethra. “After the surgery is done, plastic surgeons will reconstruct the raw areas in both babies and work on them separately,” said Dr Sripathi, adding the risks were huge, but doctors were confident of undertaking the procedure.
“The survival rate post surgery is around 80%. Post operative care is also critical. We’ve asked the parents to bring the babies back after six months for a follow-up and to do minor cosmetic work,” said Dr Sripathi. The surgery is expected to cost Rs 40 lakh or more and will be funded by the Tanzanian government.
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