Conjoined twins

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Conjoined twins (also known as Siamese twins) are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa.[1] Approximately half are stillborn, and a smaller fraction of pairs born alive have abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 25%.[2] The condition is more frequently found among females, with a ratio of 3:1.[1]

Two contradicting theories exist to explain the origins of conjoined twins. The older and most generally accepted theory is fission, in which the fertilized egg splits partially. The second theory is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together. Conjoined twins share a single common chorion, placenta, and amniotic sac, although these characteristics are not exclusive to conjoined twins as there are some monozygotic but non-conjoined twins that also share these structures in utero.[3]

The most famous pair of conjoined twins was Chang and Eng Bunker (Thai: อิน-จัน, In-Chan) (1811–1874), Thai brothers born in Siam, now Thailand. They traveled with P.T. Barnum's circus for many years and were billed as the Siamese Twins. Chang and Eng were joined by a band of flesh, cartilage, and their fused livers at the torso. In modern times, they could have been easily separated.[4] Due to the brothers' fame and the rarity of the condition, the term came to be used as a synonym for conjoined twins.[5]


Types of conjoined twins

Conjoined twins are typically classified by the point at which their bodies are joined. The most common types of conjoined twins are:

  • Thoraco-omphalopagus (28% of cases):[6] Two bodies fused from the upper chest to the lower chest. These twins usually share a heart, and may also share the liver or part of the digestive system.[7]
  • Thoracopagus (18.5%):[6] Two bodies fused from the upper thorax to lower belly. The heart is always involved in these cases.[7]
  • Omphalopagus (10%):[6] Two bodies fused at the lower chest. Unlike thoracopagus, the heart is never involved in these cases; however, the twins often share a liver, digestive system, diaphragm and other organs.[7]
  • Parasitic twins (10%):[6] Twins that are asymmetrically conjoined, resulting in one twin that is small, less formed, and dependent on the larger twin for survival.
  • Craniopagus (6%):[6] Fused skulls, but separate bodies. These twins can be conjoined at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull.[7]

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