Dual Diagnosis

Craniopagus parasiticus is a rare medical case and it is unique unlike other cases reported from different literature. In this case, the head of parasitic twins is protruding from the temporal area of cranium. Parasitic head has two deformed lower limbs; one is too rudimentary attached to the mass; long bones of bilateral lower limbs and some pelvic bones. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs are seen. There is also rudimentary labium but no vaginal opening.

Case presentation: A 38-years-old multigravida (Gravida V para IV) women from Amhara ethnicity referred from rural health center to Referral Hospital due to prolonged second state of labor at 42+1 weeks. Upon arrival she had contraction, term sized gravid uterus, and fetal heart beat was 112. On digital pelvic examination the cervix was fully diluted, station of the head was high and

the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decided to emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were 7 and 9 at 1 and 5 min, respectively. The infant appeared to be grossly normal except the parasitic

co-twin attached at the cranium. The neonate was investigated with the available investigations (CBC, X-Ray, Doppler ultrasound) and pediatric side consultation was made. After a week of counseling and investigations, successful separation operation was done. During post-operative time the neonate was comfortably suckling on breasts with no neurological deficit. The details of the surgery, post-operative condition and subsequent follow up will be discussed during the conference.

Conclusion: The possible etiologies craniopagus parasiticus is still unknown due to a rarity of cases. Doctors, Genetic Scientists, Epidemiologists and Researchers continue to investigate this case as the reasons that could give clue to birth defect and to provide answer for better prognosis of cases and to improve the life chances of the twins. This case will have some input in the effort to know the etiology and pathogenesis of this new born