BLACK SOCIAL HISTORY Conjoined twins in West Africa
OLUWATOPE A MABOGUNJE AND JAMES H LAWRIE
Department of Surgery, Ahmadu Bello University Hospital, Zaria, Nigeria
SUMMARY 12 cases of conjoined twins from West Africa were reported between 1936 and 1978.
Eight sets were liveborn and were surgically separated either in local hospitals or abroad. Four were
stillborn. Two new cases of stillborn conjoined twins were recently delivered at this hospital. The
most common type and the ones most likely to be born alive were the omphalopagi. Surgical
separation was successful in 5 cases but the twins separated at Zaria died about a month later.
Emergency operations were performed on the pygopagus and ischiopagus, and one member of the
former but both of the latter died. The thoracopagus and dicephalus twins were stillborn. However,
necropsy findings in one of the thoracopagi indicate that surgical separation would have been feasible
had the twins been born alive. The internal mechanical factors causing cardiac defects in such twins
may be relevant to the study ofthe pathogenesis ofcongenital cardiac malformations.
The incidence of conjoined twins in West Africa is
not precisely known. Studies of such twins contribute
to the knowledge of embryonic duplication, fetal
development, and the mechanism of congenital
malformations. Noonan' has stressed the relevance
of thoracopagus conjoined twins in the study of the
mechanism of cardiac malformations. We have
reported on the 2 sets of conjoined twins separated at
this hospital in Zaria. This report is a collective
review of all cases of conjoined twins in West Africa
up to 1978, plus 2 new cases of stillborn conjoined
Table 1 Type and sex distribution of conjoined twins
born in West Africa between 1936 and 1978
Type Liveborn Stillborn Male Female
(n=8) (n=6) (n=2) (n=12)
Omphalopagus (n=6) 5 1 1 5
Dicephalus (n=2) 0 2 1 1
Thoracopagus (n=2) 0 2 0 2
Diprosopus (n=1) 0 1 0 1
Ischiopagus (n=1) 1 0 0 1
Pygopagus (n=l) 1 0 0 1
Heteropagus (n=1) 1 0 0 1
twins delivered recently in this hospital-namely, a
thoracopagus and a dicephalus.
Material
All data relating to cases of conjoined twins reported
from West Africa between 1936 and 1978 were
collected. The clinical, epidemiological, surgical, and
necropsy data were analysed. The system of classification
recommended by Potter and Craig3 is used to
describe such twins (Table 1).
Results
Stillbirths (Table 2). There were 6 stillborn sets of
twins comprising 2 dicephalus twins, 2 thoracopagi,
and 1 set each of diprosopus and omphalopagus.
Although the dicephalus twins of Dakar were
delivered vaginally,4 the recent dicephalus twins of
Zaria were delivered by caesarean section because of
shoulder dystocia and rupture of the uterus. The
former had 3 upper limbs, dipus tribrachius, while
the latter had only a pair, dipus dibrachius (Fig. 1).
Table 2 Stillbirths
Year of Author Country Age of Type Sex Birthweight Shared organs
report mother (kg)
(years)
1940 Bowesman25 Gambia ? Omphalopagus F 4-5 No necropsy
1958 Stiggelbout6 Nigeria 25 Thoracopagus F 2-4 Pericardium
1971 Engman and Ghana 26 Diprosopus F 1.1 Y-eosophagus, Y-trachea,
Arkutu5 heart
1975 Sylla et al.4 Senegal 29 Dicephalus F ? Humerus, heart, liver, jejunum
1980 Mabogunje Nigeria 21 Thoracopagus F 2-3 No necropsy
1980 Mabogunje Nigeria 25 Dicephalus M 2.6 Heart, liver, jejunum
626
OLUWATOPE A MABOGUNJE AND JAMES H LAWRIE
Department of Surgery, Ahmadu Bello University Hospital, Zaria, Nigeria
SUMMARY 12 cases of conjoined twins from West Africa were reported between 1936 and 1978.
Eight sets were liveborn and were surgically separated either in local hospitals or abroad. Four were
stillborn. Two new cases of stillborn conjoined twins were recently delivered at this hospital. The
most common type and the ones most likely to be born alive were the omphalopagi. Surgical
separation was successful in 5 cases but the twins separated at Zaria died about a month later.
Emergency operations were performed on the pygopagus and ischiopagus, and one member of the
former but both of the latter died. The thoracopagus and dicephalus twins were stillborn. However,
necropsy findings in one of the thoracopagi indicate that surgical separation would have been feasible
had the twins been born alive. The internal mechanical factors causing cardiac defects in such twins
may be relevant to the study ofthe pathogenesis ofcongenital cardiac malformations.
The incidence of conjoined twins in West Africa is
not precisely known. Studies of such twins contribute
to the knowledge of embryonic duplication, fetal
development, and the mechanism of congenital
malformations. Noonan' has stressed the relevance
of thoracopagus conjoined twins in the study of the
mechanism of cardiac malformations. We have
reported on the 2 sets of conjoined twins separated at
this hospital in Zaria. This report is a collective
review of all cases of conjoined twins in West Africa
up to 1978, plus 2 new cases of stillborn conjoined
Table 1 Type and sex distribution of conjoined twins
born in West Africa between 1936 and 1978
Type Liveborn Stillborn Male Female
(n=8) (n=6) (n=2) (n=12)
Omphalopagus (n=6) 5 1 1 5
Dicephalus (n=2) 0 2 1 1
Thoracopagus (n=2) 0 2 0 2
Diprosopus (n=1) 0 1 0 1
Ischiopagus (n=1) 1 0 0 1
Pygopagus (n=l) 1 0 0 1
Heteropagus (n=1) 1 0 0 1
twins delivered recently in this hospital-namely, a
thoracopagus and a dicephalus.
Material
All data relating to cases of conjoined twins reported
from West Africa between 1936 and 1978 were
collected. The clinical, epidemiological, surgical, and
necropsy data were analysed. The system of classification
recommended by Potter and Craig3 is used to
describe such twins (Table 1).
Results
Stillbirths (Table 2). There were 6 stillborn sets of
twins comprising 2 dicephalus twins, 2 thoracopagi,
and 1 set each of diprosopus and omphalopagus.
Although the dicephalus twins of Dakar were
delivered vaginally,4 the recent dicephalus twins of
Zaria were delivered by caesarean section because of
shoulder dystocia and rupture of the uterus. The
former had 3 upper limbs, dipus tribrachius, while
the latter had only a pair, dipus dibrachius (Fig. 1).
Table 2 Stillbirths
Year of Author Country Age of Type Sex Birthweight Shared organs
report mother (kg)
(years)
1940 Bowesman25 Gambia ? Omphalopagus F 4-5 No necropsy
1958 Stiggelbout6 Nigeria 25 Thoracopagus F 2-4 Pericardium
1971 Engman and Ghana 26 Diprosopus F 1.1 Y-eosophagus, Y-trachea,
Arkutu5 heart
1975 Sylla et al.4 Senegal 29 Dicephalus F ? Humerus, heart, liver, jejunum
1980 Mabogunje Nigeria 21 Thoracopagus F 2-3 No necropsy
1980 Mabogunje Nigeria 25 Dicephalus M 2.6 Heart, liver, jejunum
626
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