Siamese twins in Indonesia were born fused together like a “spider”, in a one in 2 million phenomenon.
The twins were born in 2018 with three legs, four arms and a penis. They also share a bladder, rectum and intestine.
Only a handful of the so-called Ischiopagus Tripus conjoined twins have done so.
After defying the odds and surviving pregnancy and childbirth, the young children were unable to sit up and were forced to lie down for the first three years of their lives.
A team of surgeons performed a painstaking operation to amputate their third leg and stabilize their hip and pelvic bone so they could sit upright and give them a semblance of normality.
Conjoined twins in Indonesia were born with three legs, four arms and one penis, which is approximately one occurrence in 2 million.
The children underwent surgery to amputate their non-functioning leg and stabilize their hips so they could sit up and be more independent.
Their condition has led them to be united like a spider, a term coined by the famous conjoined twins Ganga and Jamuna Mondal of India.
Conjoined twins account for one in every 50,000 to 200,000 live births and occur when a single fertilized egg divides and develops into two individuals.
According to the Mayo Clinic, between eight and 12 days after conception, the layers that divide to form identical twins develop into specific organs and structures.
The process is believed to end prematurely, resulting in conjoined twins.
However, another theory suggests that two separate embryos fuse at an early stage of development.
Conjoined twins tend to weigh more than boys by a ratio of 3:1. And in two-thirds of cases, at least one of the twins dies or is stillborn.
Indonesian twins are Ischiopagus Tripus, which means they are joined at the pelvis.
The children were born with four functional arms, two functional legs and one non-functional leg. They also share a penis and an anus.
Doctors believe that one of the twins had an underdeveloped kidney, known as left kidney hypoplasia, while the other had only one kidney.
His parents had two older children and there was no family history of medical problems. His mother reported no complications during her pregnancy.
Researchers have noted that only a few cases have been reported in the medical literature. The Indonesian team estimated that between six and 11 percent of all conjoined twins are ischiopagus.
It is unclear how long the surgery lasted, but the twins suffered no complications afterward or after a three-month follow-up. The surgery allowed them to sit and potentially stand, offering them more independence.
A case report of conjoined twins in Pakistan showed that one of them was very underdeveloped. They both died before they could separate.
Twins born in 1989 in Pakistan were separated when they were young in a nearly 10-hour procedure
The children are two of the few Ischiopagus Tripus conjoined twins to be successfully separated.
Only a few reports have been published on Ischiopagus Tripus conjoined twins. Many of those available focus on twins who were separated.
A new report from 1994 details a pair of twins who were born in China in 1989. Each had two normally functioning arms, two functioning legs, and one fused leg that was unresponsive. The boys also had a penis and two testicles, but no anus.
Doctors separated them in 1992, when they were just over two years old. The operation lasted almost 10 hours.
Another case study focused on a pair of conjoined twins born in Pakistan in 2011. They were fused in the lower half of their bodies, and one of the twins was significantly smaller, weaker, and had a smaller head.
Their genitals were not developed enough to assign a gender to either twin and there was no clear anus. They both died before they could separate.
The new case report was published in the American Journal of Case Reports.
