Case report: Epigastric heteropagus twins and literature review

Epigastric heteropagus twins are an extremely rare congenital anomaly of conjoined twins. We present a case of epigastric heteropagus twins who were diagnosed via prenatal ultrasound imaging: the fetus (or host) was connected to the abdominal wall of the parasite (the dependent portion), and an omphalocele was present. The male infant was delivered by cesarean section at 35 + 5 weeks gestation. The parasite lacked a head and heart and presented long bones of the limbs. After abdominal computed tomography, omphalocele repair, and parasite removal were surgically performed under general anesthesia. After discharge (follow-up, 3 months), the infant is currently growing well and is healing satisfactorily. Forty-one cases of epigastric heteropagus twins were retrieved from database searches: 38 good postoperative outcomes, 2 perioperative deaths, and 1 termination. The case highlights that even when parasites are massive in size, births can present good outcomes with suitable surgical treatment

Prognostic Value of Bismuth Typing and Modified T-stage in Hilar Cholangiocarcinoma

Aim: Hilar cholangiocarcinoma (HCC) has a very poor prognosis. Surgical resection is a radical treatment option for this disease. However, it is still difficult to cure, and prognostic traits are ambiguous. Evaluation of the tumor typing and staging may elucidate effective prognosis and provide helpful advice for clinical surgeon. This study aimed to analyze the prognostic value of tumor typing and staging in HCC. Methods: We conducted a retrospective review of 85 patients with HCC undergoing surgical resections procedures at the Second Xiangya Hospital in Hunan Province between 2002 and 2012. The Bismuth type, modified T-stage, postoperative complications, survival time, and other clinical manifestations associated with the surgical treatment were analyzed. Results: Patients were classified according to Bismuth typing: Subtype I (12 cases), Subtype II (4 cases), Subtype IIIa (3 cases), Subtype IIIb (16 cases), and Subtype IV (50 cases). Patients were classified according to the T staging: Stage T1 (19 cases), Stage T2 (5 cases), and Stage T3 (61 cases). Based on data collected from 67 patients who completed the follow-up survey, both the Bismuth type and modified T-stage were significantly correlated with survival time (each P = 0.01). Conclusion: The majority of our patients with HCC were characterized as Subtype IV in Bismuth typing and Stage T3 in modified T-stage. Both Bismuth typing and modified T-stage showed prognostic value in HCC. Compared with Bismuth typing, modified T-stage is a better indicator of the resectability of HCC

Table1_Case report: Epigastric heteropagus twins and literature review.pdf

Epigastric heteropagus twins are an extremely rare congenital anomaly of conjoined twins. We present a case of epigastric heteropagus twins who were diagnosed via prenatal ultrasound imaging: the fetus (or host) was connected to the abdominal wall of the parasite (the dependent portion), and an omphalocele was present. The male infant was delivered by cesarean section at 35 + 5 weeks gestation. The parasite lacked a head and heart and presented long bones of the limbs. After abdominal computed tomography, omphalocele repair, and parasite removal were surgically performed under general anesthesia. After discharge (follow-up, 3 months), the infant is currently growing well and is healing satisfactorily. Forty-one cases of epigastric heteropagus twins were retrieved from database searches: 38 good postoperative outcomes, 2 perioperative deaths, and 1 termination. The case highlights that even when parasites are massive in size, births can present good outcomes with suitable surgical treatment.</p