1050 S.A. MEDICAL JOURNAL THE SIYEPU CONJOINED (SIAMESE) TWINS 28 October 1967 S. CVWES, M.B., M.MED. (SURG.), AND PROF. J. H. Louw. CH.M .. F.R.C.S .. Department of Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town 'Conjoined twins' is the medical term applied to twins who are physically joined together, but 'Siamese twins' is the better-known phrase for this unusual abnormality which has intrigued both layman and physician for many centuries. There are five types of conjoined twins. In the com- monest variety called thoracopagus, xiphopagus or sterno- pagus, the twins are joined at the chest, sternum, or xiphisternum and face each other. The liver is often fused and the wider the attachment, the greater the possibility of a common heart or intestinal tract. The second variety, joined only at the umbilicus, is called omphalopagus and may have fusion of livers or gastro-intestinal tracts. In the' third variety, joined at the heads and referred to as craniopagus, the fusion is usually median, but may be vertical, occipital or parietal. The two brains may be connected by a bridge of neural tissue, although they are usually separate. The fourth variety, pygopagus twins, are joined at Ihe sacrum and coccyx, and face away from each other. They may have a single spinal cord at this level and there is often fusion in the perineal region with a single common anus. The fifth variety, ischiopagus twins, are joined at the pelvis. The urogenital organs are usually shared. From an analysis of the records of 117 cases, Robert- son' determined the incidence of the various types as being 73 0 0 thoracopagus, 19°0 pygopagus, 6°0 ischiopagus and 2°0 craniopagus. Female conjoined twins occur 2-3 times more com- monly than males.,·3 Excellent papers on the historical aspect of conjoined twins have been written by Luckhardt: Aird.',ti and Drag- stedt,' while details of the investigations and preparation before separation. and of the operation, have been well outlined by Aird' and HiIr for thoracopagus twins, by Koop' for pygopagus twins and by O'Connell et al." for craniopagus twins. While well over 400 cases of conjoined twins have been described, reports of only 26 who came to operation"3"".,, have appeared in the English literature. Of these 26 cases, 14 were successfully separated with immediate survival of both babies",··1.'."''',,,,,,, but in only 10 instances have both babies survived separation long term.',','·"'·I4·"·" THE SIVEPU TWI S The Siyepu conjoined twins were born III Butterworth, South Africa. to a 33-year-old mother (Fig. I) of the Fingo race on 12 ovember 1966. The mother had had four previous normal pregnancies and there was a history of twins in the family. The twins were spontaneously delivered at home, unattended. Both were vertex in pre- sentation, the one head preceding the other. The mother and babies were admitted initially to the Butterworth Hospital, from where the twins were trans- ferred by air to the Red Cross War Memorial Children's Hospital, Cape Town, and admitted to the surgical neo- natal unit. The baby girls were then aged 12 hours and in good condition except for the presence of jaundice. The combined weight was 7t lb. and they measured 37·5 cm. Fig. 1. Parents, grandmother and brother of the twins. Fig. 2. The twins on admission, showing the extent of the connecting bridge.
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