Surgical Separation of Thoraco-omphalopagus Conjoined Twins after SARS-CoV-2 Infection-Thoracic Surgery Perspective: A Case Report
Published: 2021-11-01
Page: 705-711
Issue: 2021 - Volume 4 [Issue 2]
. Wuryantoro
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
David Hutagaol
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
William Makdinata *
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Primayudha Dirgatama
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Rigel Kent Paat
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Moira Setiawan
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Conjoined twins are a rare phenomenon of monochorionic monoamniotic twins, with an incidence of 1 in 50,000 to 200,000 births. They have a low survival rate of 7.5%, and 40% of surgically separated twins don’t survive. The SARS-CoV-2 infection has contributed to 178 million infections globally and 3.8 million deaths. Surgery after a previous SARS-CoV-2 infection should be timed to ensure the safest delivery of perioperative care. It may cause multisystem disease with short and long-term sequelae that could impact postoperative recovery. We report a case of 16-months-old thoraco-omphalopagus twins with complaints of fever and respiratory distress. The twins tested positive for SARS-CoV-2 infection, and one of them continued to experience recurrent desaturation with respiratory acidosis. The patient was not able to wean from the ventilator and had recurrent ventilator-associated pneumonia. Imaging of the lungs showed consolidation in the 2nd and 3rd segment of the right lung of one of the twins and multiple consolidations in the 1st, 2nd, 3rd, and 6th segment of the left lung, accompanied with ground glass opacities in the 1st and 2nd segment of the right lung of the other, both suggestive of pneumonia. Thus, we decided to undertake elective surgery for separation of the twins, two months after their SARS-CoV-2 infection had resolved. A multidisciplinary team performed a successful separation of the twins with minimal blood loss and no intraoperative complications. The postoperative assessment showed no signs of chronic pulmonary dysfunction, and the patients were able to wean from the ventilator after the procedure.
Keywords: Conjoined twins, SARS-CoV-2, thoracic surgery, thoraco-omphalopagus