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A male baby (weight: 3150g) was born through cesarean section at 35 weeks of gestation to a 32-year-old primigravida with a history of substance abuse. APGAR scores were 7,8 and 8 at the 1st, 5th, and 10th minutes, respectively. The baby developed respiratory distress soon after birth requiring intubation and mechanical ventilation. Physical examination revealed conjoined twins with the autosite having an abdominal wall defect consistent with omphalocele and the parasitic twin joined to the autosite at left hemithorax (Fig.1). The parasite twin had two upper limbs, two lower limbs, and a phallus with an absent scrotum. An echocardiogram of the autosite showed an interventricular septal defect. A contrast-enhanced abdominal CT scan revealed a parasite twin having an ectopic kidney at the level of epigastrium with associated omphalocele containing a pseudocyst. There was also a large cystic structure suggestive of megabladder. The arterial supply to the parasite was from the internal mammary and superior mesenteric arteries of autosite.

Thoracic heteropagus twins with an omphalocele