Conjoined Twins
Overview
- Conjoined twins occur once in every 50,000 to 60,000 births. Most are stillborn.
- Approximately 75 percent of conjoined twins are joined at least partially in the chest and share organs with one another. If they have separate sets of organs, chances for surgery and survival are greater than if they share the same organs.
- Approximately 70 percent of conjoined twins are female.
- Doctors at The Children's Hospital of Philadelphia have separated 15 sets of complete or partially conjoined twins and have managed the care of many others whose separation was not surgically possible.
Connection patterns
Example of conjoined twins connected at the chest with a shared heart and liver.
© CHOP/CFDT
View larger image »Conjoined twins are generally classified three ways:
- 73 percent are connected at mid torso (joined at the chest wall or upper abdomen)
- 23 percent at lower torso (sharing hips, legs or genitalia)
- 4 percent at upper torso (connected at the head)
In cases of conjoined hearts at ventricular (pumping chamber) level, there are no known survivors.
Separation success rates
The success rates for separating conjoined twins vary depending on the connection. The following list shows conjoined twin cases at The Children's Hospital of Philadelphia and outcomes for separations, when attempted.
- 1957 Children's Hospital separated its first set of conjoined twins, joined at the buttocks. One died at age 9 of unknown reasons after open-heart surgery; the other is now married.
- 1961 Lori and Dori Schappell, joined at the head, have been managed at Children's Hospital since birth for multiple congenital abnormalities. Separation was not felt to be possible.
- 1968 Baby born with partial twin had the duplication of his lower body removed.
- 1974 Clara and Alta Rodriguez were separated by a 23-person team in a 10-hour surgical procedure. Alta died at age 3, after choking on a bean. Clara is living a healthy life in the Dominican Republic.
- 1977 Baby A and Baby B - the decision to perform surgery was made although it was known that one twin would not survive because the shared heart could only go to one child. Baby B, the surviving twin, died three months later of liver failure and overwhelming infection.*
- 1978 Baby A and Baby B were conjoined from the chest through the pelvis; one survived and one died following the separation.
- 1979 Baby A and Baby B had conjoined heart, liver and G.I. tract. Separation was not attempted and infants died two days after birth.*
- 1984 Claire and Emily Taylor, joined at the pelvis and abdomen, were successfully separated by a 16-person surgical team. Both girls are at home in Portage, Wisconsin and are doing well.
- 1985 Baby A and Baby B had conjoined heart, liver and G.I. tract. Separation was not attempted and infants died one day after birth.*
- 1985 Baby A and Baby B, with conjoined liver, biliary tract and upper bowel, were separated on July 8, 1985. Both babies succumbed to overwhelming infection several months after surgery.
- 1986 Baby A and Baby B had a conjoined heart, similar to the twins in 1977 and 1979. Baby B, surviving twin, died within hours after surgery of heart failure.*
- 1987 Baby A and B, joined at the pelvis and abdomen like the Taylor twins, were successfully separated and are doing well.
- 1991 Baby A and Baby B girls were born with conjoined livers. Both survived and are doing well.
- 1991 Baby A and B were successfully separated from the lower part of the chest to their hips and are doing well in New England.
- 1993 Amy and Angela Lakeberg were conjoined at the heart and liver. Angela, the surviving twin, died several months after surgery.*
- 1995 Baby A and Baby B had a conjoined chest and pelvis. Separation was not attempted and the infants died of respiratory distress, a result of premature birth.
- 1996 Baby A and Baby B were joined at the chest and pelvis and had additional anomalies. Separation was not possible and the infants died shortly after birth.*
- 1998 The Center for Fetal Diagnosis and Treatment at Children's Hospital of Philadelphia diagnosed numerous anomalies. The parents decided to terminate the pregnancies.
- 1999 Weronika and Wiktoria Palen, joined at the chest and abdomen, were successfully separated by a12-person surgical team. Both girls are doing well and have returned to their home in Poland.
- 2000 Thoracoomphalopagus conjoined twins with shared heart delivered by EXIT procedure with immediate separation. Twin B expired at time of separation due to anomalous heart. Twin A had one month stay in NICU. Ischiopagus conjoined twins delivered in Mississippi, transferred to CHOP at month of age. Separation and discharge to home in Mississippi after NICU stay.
- 2003 Baby A and baby B, joined at the pelvis and abdomen, were successfully separated and are doing well
- 2006 Twin A and Twin B joined by a portion of liver. Separation at day of life one. Discharged to home in Virginia, alive and well.
* These conjoined twins shared a single heart.
Over the years, survival rates have improved as a result of more accurate imaging studies and better anesthetic and operative techniques.
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