3 August 2017

Tanzania: Separation of Kilosa Conjoined Twins Possible At Six Months, Doctors Say

Photo: Mohamed Mambo/Daily News
Muhimbili National Hospital paediatric surgeon Zaitun Bokhary addresses reporters on the imminent separation surgery for the conjoined twins.

Surgeons at Muhimbili National Hospital (MNH) have revealed that the surgical separation of conjoined twins from Chaumbele Village, Kilosa District in Morogoro Region can be performed after they have reached the age of six months.

The conjoined twins, who are fused at the lower chest and abdomen, share the liver and some veins of the heart, but they have different digestive systems.

Paediatric Surgeon at MNH, Dr Zaitun Bokhary said after performing various tests, they observed that it was possible to separate them. "Surgical separation of conjoined twins is a delicate and risky procedure requiring extreme precision and care, thus it calls for multidisciplinary approach.

"After six months, the twins will be in a good state for such kind of an operation," she noted. Dr Bokhary said it is possible for the surgical separation to be conducted in Tanzania; however, lack of surgeons can hold back the 20-hour procedure.

The first recorded set of conjoined twins in Tanzania was successfully separated on the 10th of February, 1994 at the then Muhimbili Medical Centre (MMC) in Dar es Salaam.

The male omphalopagus twins were born to a 22-year old by normal vaginal delivery at a Rural Health Centre in Shinyanga Region two months earlier and had been transferred to the National Referral Hospital at the age of two weeks.

At four months, the first twin died following multiple complications which necessitated several re-operations, while the second twin was discharged to his home village in May 1994. Conjoined twins are genetically identical and are therefore always the same sex.

They develop from the same fertilised egg and share the same amniotic cavity and placenta.

An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southeast Asia and Africa.

On what causes conjoined twins, Dr Bokhary said a woman only produces a single egg, which does not fully separate after fertilisation.

The developing embryo starts to split intoidentical twins during the first few weeks after conception, but stops before the process is complete. The partially separated egg develops into a conjoined fetus.

"We cannot say there is a particular reason for conjoined twins, but there are several factors that may cause it including women not attending clinic during pregnancy so they don't get important vaccines to protect them and their babies," she elaborated .

The twins were born on July 21, this year, to a 42-year old mother Rebecca Mwendi. The female twins were referred to MNH on July 24, in which they were placed in the paediatric intensive care unit (ICU).

The surgeon further said they performed several tests on the twins including echocardiogram to outline their heart's movement, liver function test, CT Thoracoabdominal, renal function test and CT angiogram to visualise arterial and venous vessels throughout the body.

"During the tests we observed that the second twin had a fracture proximal third of the femur which is already immobilised by paediatric orthopaedic surgeons," Dr Bokhary said.

She added, "The twins are going on well and we are currently making sure they get proper breastfeeding so that they can later withstand the separation surgery."

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