Anatomical, Embryological and Ethical Aspect of Conjoined (Siamese) Twins
Authors:
E. Kubíková 1; I. Varga 2,3; H. El Falougy 1; Š. Polák 2; J. Beňuška 1
Authors‘ workplace:
Anatomický ústav, Lekárska fakulta, Univerzita Komenského, Bratislava
prednosta prof. MUDr. J. Beňuška, PhD.
1; Ústav histológie a embryológie, Lekárska fakulta, Univerzita Komenského, Bratislava
prednosta doc. MUDr. Š. Polák, CSc.
Ústav fyziológie a patofyziológie, Fakulta zdravotníckych špecializačných štúdií
2; Slovenská zdravotnícka univerzita, Bratislava
prednosta doc. MUDr. I. Béder, CSc.
3
Published in:
Čes-slov Pediat 2009; 64 (1): 33-39.
Category:
Review
Overview
Conjoined (Siamese) twins are rare developmental anomalies, which draws attention not only in the scientific community, but in the whole society. Siamese twins are rare result of fission of the monozygotic twins, because the separation of embryos occurs in the stage of the primitive streak (in the 3rd week of development). In this stage the three germ layers give rise to the primitive organs.
Fission of embryos in the stage of the primitive streak in general is not complete; the cells are not equally separated in two embryos. However other theory explains the formation of conjoined twins on the base of fission and later fusion of two germ discs originating from the same zygote. This theory confirms the fact, that if the embryo fissioned before the development of the notochord, each Siamese twin will have its own notochord.
In this work authors review the knowledge about the etiology and pathogenesis of the conjoined twins. They present the incidence and the clinico-anatomical classification of this developmental anomaly. The work summarizes the information about the cases of conjoined twins in Slovakia. In the last 40 years were born 6 conjoined twins in Slovakia; 3 cases were separated by surgical procedure. The experience of the Slovak physicians confirms that accession to the surgical separation depends on the clinical findings, viability of both children, and on their basic vital functions. In convenient conditions the surgical separation can be postponed for weeks, months or years (Slovak cases from the years 2000 and 2007). In the case of life threatening or death of one of the conjoined twin, an urgent surgical separation has to be performed to save the more viable twin (Slovak case from the year 1986).
The ethical and moral problems related with the decision of surgical separation still unanswered, mainly in the case of unequal viability of both twins. In this work authors review the moral and ethical aspects in relation with the known cases of separated conjoined twins.
Key words:
conjoined (Siamese) twins, etiology, classification, occurrence in Slovak Republic, medical ethic
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Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
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