Siamese twins - causes of birth and examples of separation of monochorionic monoamniotic twins. Surgery to separate conjoined twins
Nowadays, Siamese twins are no longer as rare as they used to be. There are several explanations for this: firstly, the number of people with congenital anomalies depends on the total population of the planet, and secondly, medicine has stepped far forward, and conjoined twins now much more likely to survive birth. They were once considered freaks, but now they are treated differently. Many conjoined twins can be separated, but some choose to live together their entire lives.
However, just a few decades ago, all Siamese twins had the same destiny - to serve as amusement to the public. For them, this was the easiest way to make a living, and often even make good money. We want to tell you about several Siamese twins who were famous in the past.
1. Byzantine twins
A pair of unnamed conjoined twins managed to survive infancy in the 10th century, as evidenced by records left by several historians of the time. Ten centuries ago, Siamese twins were few and far between ancient world congenital anomalies were considered a bad omen, and so children were often allowed to die.
The boys were born in Armenia and came to Constantinople as adults. They were famous at the imperial court, and later wandered around the villages, exposing themselves. Around the time of the reign of Constantine in the 7th century. In the mid-900s they returned to Constantinople, where one of the twins died. Doctors attempted to separate them - this was the first operation of this kind in history. Unfortunately, the second twin only managed to live for three days.
2. Hungarian sisters
Helen and Judith were born in Hungary in 1701, supposedly three hours apart. Whether this is true or not, the frightened and exhausted mother was presented with a terrible sight: the girls’ pelvises were fused, back to back. From age two to nine, girls were paraded throughout Europe and examined by local doctors in each country.
The sisters learned many languages and sang duets for the public. Judith, the second-born sister, was physically weaker: at the age of six she suffered a stroke, as a result of which the left half of her body was paralyzed, so she subsequently relied on the stronger Helen when walking.
When the girls were nine years old, they went to a monastery, where they lived in solitude until their death; they died on the same day at the age of 22.
3. Chang and Eng Bunker
Chang and Eng Bunker were born in Thailand (at that time the state was called Siam) in 1811. Their birth caused such a stir that the King of Siam ordered the children killed, but the mother refused to give up her boys, so the king's order was not carried out. They became so famous that a few years later all conjoined twins began to be called “Siamese twins,” but if we talk specifically about Chang and Eng, they were called that simply because they were born in Siam.
British trader Robert Hunter came across the twins when they were teenagers and decided to take them to England. For years, Chang and Eng traveled around England and the United States, showing off their bodies and abilities. When they turned 21, Chang and Eng took over their business and began to earn big money.
In 1839 they quit show business and bought a farm in North Carolina. They married two sisters, despite the objections of the girls' parents, and gave birth to 21 children. Several times Chang and Eng asked the doctors to separate them, but at that time the doctors did not even undertake to say what would happen. They remained conjoined until their death in 1874: when one twin died, the other lived only three hours.
4. Millie and Christina McCoy
Millie and Christina McCoy were born in North Carolina in 1851 into a family of slaves owned by Jebez McCay. When they were eight months old, the owner sold the twins and their mother to John Purvis. Purvis resold them to Joseph Pierson Smith and his partner named Brower. Then the girls were kidnapped, they were found only three years later in England and returned to the USA.
As the girls grew older, they learned to sing a duet for the show. Their owner died in 1862, and the twins were inherited by his youngest son Joseph, who came up with another legend for them. He told the audience that in front of the audience were not Siamese twins, but one girl with two heads, four arms and four legs. Millie and Christina appeared on stage under the pseudonym Two-Headed Nightingale and were renamed Millie-Christina, as if they really were one person.
They sang, danced and played musical instruments; the girls enjoyed great success and, after the abolition of slavery, earned a lot of money by touring for themselves. The sisters left show business at the age of 58, settling in North Carolina in the city of Columbus and again becoming Millie and Christina.
They died in 1912 at the age of 61, 17 hours apart.
5. Giovanni and Giacomo Tocci
Giacomo and Giovanni Battista Tocci were born in Locane, Italy, around 1875 or 1877. Their father was so shocked by the arrival of the twins that he went crazy and was admitted to a mental hospital about a month after the birth of his sons.
It seemed that the sons were one boy with two torsos growing from one belt, but in fact they were two different people. When doctors in Europe examined them, this was confirmed: each twin could feel and control only one leg - they never learned to walk on their feet, but they could crawl.
Most of the time the twins got along quite well, but during conflicts they exchanged punches. The Tocci brothers spent their childhood touring Europe, and in 1891 they moved to America, where they spent five years. In 1897, having almost reached adulthood, Giacomo and Giovanni settled in a villa in Venice, voluntarily withdrawing from society and leading an extremely secluded lifestyle.
About them later life little is known. There were untrue rumors that they married two women. They died after 1912, but exact date their deaths are also unknown.
6. Rosa and Josepha Blazek
Rosa and Josefa Blazek were born in Skrezov, Bohemia (now the Czech Republic) in 1878. The sisters were fused at the pelvis and shared enough bones to make separation impossible. For many years the Blazeks toured, but gradually the number of visitors, and therefore the money, became less and less.
In 1909, news appeared in the newspapers that Rosa was pregnant, and in 1910 she actually gave birth to a boy named Franz. As for the father, some newspapers wrote that it is known who this man is, but his marriage to Rosa is impossible, because in fact it would be bigamy. Others wrote that he and Rosa were married, but he died in the war.
Rose herself never said who the father was, and the child grew up an orphan, which significantly supported the twins’ careers - little Franz always accompanied Rose and Josepha during their tours. When the sisters fell ill in 1922, their brother suddenly appeared, declaring that he would take care of the sisters. In fact, he wanted to make sure that they were still not separated and that he would inherit their entire fortune.
The twins died almost simultaneously, and their fortune was $400.
7. Orissa sisters
Charming Radika and Dudika Naik were born in 1888 in Orissa, India. Local residents decided that fused babies were a bad omen, and the father wanted to separate them himself, but Radika and Dudika were fused with cartilage on their chests, just like Chang and Eng Bunkers.
In 1888, the girls were bought by a showman nicknamed Captain Colman - he began to show them in Europe as “exotic” Indian twins. They gained enormous fame when, in 1902, Dudika contracted tuberculosis, and Dr. Eugene-Louis Doyen from Paris urgently performed a separation operation to save at least Radika’s life.
The operation was successful, the girls were separated, but the next day Dudika died: an autopsy showed that the cause of her death was tuberculosis, and not the separation operation. However, Radika also suffered from tuberculosis and died in a Paris sanatorium a year later. Dr. Doyen filmed the operation, and as a result, the film was shown to the audience instead of the twins.
8. Violetta and Daisy Hilton
Violetta and Daisy Hilton were born in the UK in 1908, they fused in the pelvis, but they did not have any vital common organs. The twins were bought by Mary Hilton from their barmaid mother, and the girls appeared at their first show at the age of three.
The girls sang, danced and played musical instruments, giving performances throughout Europe and the United States, and when Mary Hilton died, the twins went to her daughter and son-in-law. In 1931, they sued their “masters” and received freedom and $100,000.
They then came up with their own theatrical production and continued to tour with that number even when they were older. They starred in two films, Freaks in 1932 and their own fictionalized biopic Chained for Life in 1951.
In 1961, their tour manager abandoned them in North Carolina, and they had to take a job at a local grocery store - where they remained until their death from influenza in 1969. According to a forensic examination, Violetta lived for another two to three years after Daisy's death. four days, but she had no way to call for help.
9. Simplicio and Lucio Godina
Simplicio and Lucio Godina were born in 1908 in Samar, Philippines. The two boys were fused with cartilage and skin in the pelvis, back to back, yet flexible enough to be able to turn to face each other. On tour in the United States, 11-year-old boys were seen by a wealthy Filipino, Theodore Yangeo, who took them to Manila, raised them in luxury and took care of them. good education.
In 1928, Simplicio and Lucio married twin sisters (not Siamese) Natividad and Victorina Matos. True, at first the Godin brothers had to prove in court that they really were two different people - difficulties arose with this when the clerk refused to give them marriage certificates. When the process was completed, both couples were married, and Simplicio and Lucio played musical instruments and danced with their wives.
In 1936, when the Godin brothers were still young, Lucio contracted pneumonia. An emergency separation operation was performed immediately after his death, but Simplicio contracted spinal meningitis and died 12 days later.
10. Margaret and Mary Gibb
Margaret and Mary Gibb were born in Holyoke, Massachusetts in 1912. They were luckier than many other Siamese twins: their parents didn't want to flaunt them, sell them or exploit them. They also did not want to separate the girls, although several doctors suggested surgery, no doubt inspired by Dr. Doyen's success.
Margaret and Mary were homeschooled privately. But at the age of 14, they decided that they could make their own decisions about their lives, and went to New York in the hope of becoming successful actresses. Over the next few decades they played in small theaters and performed in the circus.
Twice there was a rumor that Margaret was engaged, and once people began to say that the twins would soon be separated. But they were never separated, and none of the sisters got married either, so all these rumors could have just been a publicity stunt.
The twins returned to Holyoke in 1942 and opened a store. In 1949, they completely retired and lived a quiet, unremarkable life until 1966, when Margaret was diagnosed with cancer. But even then, the Gibb twins refused separation surgery and died within minutes of each other in 1967.
Once upon a time, all Siamese twins had the same fate - to serve as amusement to the public. Today's world is not so cruel, but not many twins like this are happy. We want to tell you about the difficult and often tragic fates of these people.
Siamese twins are identical twins, which are not completely divided in the embryonic period of development and have common body parts and/or internal organs. The chance of such people being born is approximately one in 200,000 births. More often, Siamese twins are born girls, although the first two pairs of the most famous Siamese twins were born boys. But if we discard science and “turn on” feelings, then you will not envy the fate of these people.
1. Unnamed Siamese Twins
The earliest case of the birth of Siamese twins was scientifically recorded and dated to the year 945. This year, two fused boys from Armenia were brought to Constantinople for medical examination. A pair of unnamed Siamese twins managed to survive and even grow up. They were well known at the court of Emperor Constantine VII. After the death of one of the brothers, doctors made the first ever attempt to separate Siamese twins. Unfortunately, the second brother also did not survive.
2. Chang and Eng Bankers
The most famous pair of Siamese twins were the Chinese Chang and Eng Banker. They were born in 1811 in Siam (modern Thailand). Later, all twins born with such a physical anomaly began to be called “Siamese.” Chang and Eng were born with fused cartilage in their chests. In modern science, this type is called “xyphopagus twins”, and such twins can be separated. But in those days, boys had to perform in the circus to entertain the public in order to survive. For many years they toured with the circus under the nickname “Siamese Twins” and became famous throughout the world.
In 1839, the brothers stopped performing, bought a farm and even married two sisters. They had completely healthy children. These famous brothers died in 1874. When Chang died of pneumonia, Eng was asleep at the time. Waking up and finding his brother dead, he also died, although before that he was healthy.
3. Millie and Christina McCoy
Another famous case of the birth of conjoined twins occurred in 1851. In North Carolina, a pair of conjoined twins, Millie and Christina McCoy, were born into a family of slaves. When the babies were eight months old, they were sold to D. P. Smith, a famous showman. It was assumed that when the girls grew up, they would be used to perform in the circus. They began performing at the age of three and were known as the “Two-Headed Nightingale.” The girls had a musical education, sang well and played musical instruments. The sisters toured until they were 58, and died in 1912 from tuberculosis.
4. Giovanni and Giacomo Tocci
Siamese twins Giovanni and Giacomo Tocci were born in 1877 in Italy as dicephalic twins. They had two heads, two legs, one torso and four arms. They said that when their father saw the kids, he did not survive the shock and ended up in a psychiatric clinic. But resourceful relatives decided to extract some benefit from the misfortune and forced the boys to perform in public. But Giovanni and Giacomo had a dislike for this and were difficult to “train.” They never learned to walk because each head only had control over one of the legs. According to some sources, the Tocci brothers died in early age. Their difficult life was described in one of his stories by the famous writer Mark Twain.
5. Daisy and Violetta Hilton
These girls were born in 1908 in Brighton, England. They were fused in the pelvic area, but they did not have any vital common organs. At first, their fate was extremely sad. From birth, they were doomed to perform in various show programs. The twins were bought by Mary Hilton from their barmaid mother, and they began their first performance while still very young. The girls sang and played musical instruments, touring throughout Europe and America. After the death of Mary Hilton, her relatives began to “patronize” the girls. And only in 1931, Daisy and Violetta were able to obtain their long-awaited freedom and 100 thousand dollars in compensation through the court.
The twins continued to perform and even came up with their own program. They toured when they were already elderly and even starred in two films, one of them was biographical and called “Chained for Life.”
Daisy and Violetta Hilton died in 1969 from the flu. Daisy died first, and Violetta remained alive for some time, but she did not have the opportunity to call anyone for help.
6. Simplicio and Lucio Godina
These two boys were born in 1908 in the city of Samar in the Philippines. The case is unique in that they were fused with cartilage in the pelvic area back to back, but at the same time they were so flexible that they were able to turn to face each other. When the twins turned 11 years old, they were taken in by a wealthy Filipino, Theodore Yangeo. He raised the boys in luxury and took care of their good education. In 1928, Simplicio and Lucio married twin sisters (not Siamese) and lived together happy life until 1936, when Lucio contracted pneumonia and died. The decision was made to perform emergency surgery to separate the twins, but Simplicio contracted spinal meningitis and died 12 days after his brother's death.
7. Masha and Dasha Krivoshlyapov
The most famous Siamese twins of the USSR, Masha and Dasha Krivoshlyapov, were born on January 4, 1950. Their tragic fate is known to every Soviet person. The sisters were born with two heads, four arms, three legs and one common body. When one compassionate nurse showed the girls to their mother, the poor woman lost her mind and ended up in a psychiatric clinic. The sisters met their mother only when they were 35 years old.
For the first seven years, the girls were kept at the Institute of Pediatrics of the USSR Academy of Sciences, where they were used as “guinea pigs.” From 1970 until their death in 2003, the Krivoshlyapov sisters lived in a boarding school for the elderly. IN last years Masha and Dasha often drank in their lives.
8. Abigail and Brittany Hensel
Sisters Abigail and Brittany Hensel were born in the western United States, in New Germany. On March 7, 2016, they turned 26 years old. Their life is a vivid example of the fact that, while remaining a single whole, you can live a completely normal life. full life. The Hensel sisters are dicephalic twins. They have one body, two arms, two legs, three lungs. Each has its own heart and stomach, but the blood supply between them is common.
Abigail and Brittany live with their parents, younger brother and sister. Each of them controls the arm and leg on their side, and each only feels touch on their half of the body. But they have learned to coordinate their movements very well, so much so that they can play the piano and drive a car. The residents of their small town know the sisters well and treat them well. Abby and Brit have many friends, loving parents and a very fulfilling life. The sisters recently graduated from university, and each received a diploma. Now they teach mathematics in primary school. Their attitude to life and ability to overcome any difficulties is a special gift.
9. Krista and Tatiana Hogan
These wonderful babies were born in 2006 in Vancouver, Canada. At first, doctors gave a very small chance that the girls would survive. Even before they were born, they suggested that the mother have an abortion. But the young woman insisted on leaving the children, and never regretted her decision. The girls were born healthy, and the only thing that distinguished them from ordinary children was that their sisters were fused with their heads. The twins grow and develop as children their age should. They speak well and even know how to count. Their parents simply adore them and always say that they are healthy, beautiful and happy.
There will be a lot more in Ben Carson's life highlights, including work with other pairs of conjoined twins. Why did this story become so important? The fact is that craniopagia (the phenomenon of twins fused with their heads) has always been considered a complex pathology, almost inoperable, because we're talking about not about the skull, but about the brain, which needs to be divided into two parts without damaging it. But craniopagia is rare. And what other deviations occur, what is the reason for this “mistake of nature” and what is the fate of the Siamese twins - let’s try to figure it out.
Division error
If all cases are taken into account, the probability of a pair of conjoined twins being one in 50,000. Therefore, scientists have not been able to collect enough data to find a convincing answer to the question of the preconditions for the deviation. Science already knows that the cause of the connection is a violation of the development of the zygote (fertilized egg). And here there are two points of view - division or merger. IN normal course multiple pregnancy separation into two organisms occurs on the 3rd–8th day after conception. And a delay until the 13th-14th day leads to the appearance of Siamese twins: the zygote does not divide completely and both fetuses continue to develop fused. According to another theory, the zygote begins dividing too early, and then the future organisms at some point partially “glue” back together. And two babies developing in the mother’s belly turn out to have a common organ or even a set of organs.
But why does it fail? Research offers a lot of theories, none of which can yet be either refuted or definitively confirmed. Delayed zygote cleavage can be caused by genetic factors or exposure to toxic substances. There is even an assumption that the development of the fetus in this case is influenced by psychiatric abnormalities (split personality and increased stress).
Modern methods prenatal diagnostics(ultrasound, MRI) allow doctors to prepare for possible complications at the birth of Siamese twins. If the lives of the united children are not in danger, then the separation is not carried out immediately: the newborns are given the opportunity to get a little stronger. Fortunately, current surgical techniques are effective and survival prognoses after surgery have improved significantly.
One or two?
The rise in successful separation operations raises ethical questions for society. Should conjoined twins be considered one person or two separate individuals? Give them one or two sets of documents? How to bring to legal or criminal liability if the crime was committed by one of the conjoined twins? These and other problems are discussed both in scientific circles and among practicing lawyers, doctors, and psychologists.
The first question is whether it is necessary to continue the pregnancy when the pathology becomes known? While monitoring the development of embryos and subsequently, when deciding whether to separate or preserve the connection between two twins, doctors are constantly faced with an ethical dilemma: are conjoined twins one person (after all, they may have many common organs, including the brain! ) or two. Separation becomes the main goal after birth, and its meaning is not just to save both twins' lives, but to improve its quality. What choice to make if on the scales - freedom against possible death? In 2003, an operation to separate sisters Ladan and Laleh Bijani from Iran ended in the death of 29-year-old girls, joined at the head. The sisters knew that a sad outcome was very likely, but they went for it, as they themselves stated, for the sake of hope for freedom. It is even more difficult to make a choice when it is known in advance that one of the twins will be doomed, while the other will get a full life.
This formulation of the question emphasizes that, being unseparated, conjoined twins cannot lead productive lives. However, there are examples that prove otherwise. Daisy and Violetta Hilton, joined at the hip, have been performing in public since the age of three. Famous actresses and fashion models of the 1930s, the sisters had many suitors and were married, enjoyed communicating with journalists like real stars, and were friends with Harry Houdini.
Important and widely discussed ethical question- whether twins should be considered one or two separate persons. The most common view is that twins with individual brains and two bodies are still two separate people. However, this is a concern for twins with two separate heads and a common body. Conducted research suggests that from a psychological and intellectual point of view, unseparated twins still develop two different personalities over the years, which means they are two people with equal rights.
Greetings from Siam
For centuries, people have considered conjoined twins either gods or omens of trouble. The myth of the two-faced Janus, an ancient Roman deity, most likely alludes to Siamese twins. One of the oldest images of conjoined twins is a figurine of a “double goddess” found in Ankara. According to scientists, the figurine depicting two people joined at the sides is about 3,000 years old. Similar finds were made in Mexico, where the same ancient figurines with several heads were found.
The earliest document describing a case of fusion tells of sisters Mary and Eliza united at the waist and shoulders. The Biddenden Maidens, as they are called, were born in 1100 and lived for 34 years.
The first documented attempt at separation was made in the 10th century in Byzantium. One of the twins died, and surgeons of that time tried to separate him from the living one. But two days later, the second brother also died. And the first more or less successful attempt was made by the Swiss Johannes Fatio in 1689: he successfully separated two girls with fused stomachs, but his fame was gained by another doctor - Emmanuel Koenig, who described this case in a scientific journal.
Conjoined twins got their informal name from the story of Eng and Chang Bunker, born in Siam in 1811. Bunkers fused in the chest area have lived long life, performed in the circus and were widely known in the world.
Types of anomalies
Due to the structural features of Siamese twins, the question of possible separation is considered every time individually- there are no uniform methods. Science classifies conjoined twins based on their "common place". And each type of pathology has its own embryological history, leading to irregular shapes. We will only mention the most common anomalies.
Omphalopagus
The twins are joined in the abdominal cavity, from the lower rib cage to the groin. In 2013, in the Altai Territory, doctors not only separated two omphalopagus girls, while giving each independence and full life. The chief surgeon, having heard about the story of Siamese twins, who after the operation were embarrassed by the absence of a navel on their stomach, thought through this subtle point.
Thoracopagi
This option differs from omphalopagia in that the twins share a heart or any part of the heart tissue.
In 2003, newborns Masha and Anya Yakushenkov were operated on in St. Petersburg: the girls were fused at the chest and abdomen. During the operation, it turned out that the twins’ two hearts were located in one cardiac sac. However, this did not prevent the surgeons from completing the work successfully, and one of the girls later underwent additional heart surgery.
Pygopagi
Connected at the back at the sacrum. In January 2017, two 11-month-old pygopagus Bellany and Balleny Camaho were separated in New York. In preparation for the complex operation, surgeons worked with a 3D model of the twins' lower parts. The girls had common genitourinary organs and part of the gastrointestinal tract, as well as connected spines.
Ishiopagus
They are connected mainly at the pelvis, but can be connected up to the diaphragm - both facing and back to each other. One of the most famous stories of separation in Russia is the fate of twins Zita and Gita Rezakhanov. They went for surgery in 2003 at the age of 11. Zita died 12 years later from illness, Gita is still alive.
Craniopagus
This is a rare form of conjugation in the cranial region, accounting for 2 to 6% of all conjoined twins. These twins often have normal limbs. Attachments can be in any area of the skull.
At the Burdenko Moscow Institute of Neurosurgery in 1989, academician Alexander Konovalov performed an operation to separate two girls from Lithuania - Vilia and Vitalia Tamulevichus. The twins were 11 months old. Now only the deformed skull reminds the girls of this fact; otherwise they are healthy.
Throughout human history, many cases of conjoined twins have been described. Actually, this pathology itself is rare - 1 case in 50 thousand. Moreover, since most Siamese twins do not survive childbirth, it is customary to talk about the ratio of 1: 200,000. Among Siamese twins, three times more girls than boys, and most often these are same-sex couples. Although there are isolated cases of heterosexual twins.
Over the past half century, the number of operations for successful separation has been growing, but there are also stories of couples who remain united throughout their lives. For example, Americans Ronnie and Donnie Galion celebrated their 65th anniversary last year and are the longest-living Siamese twins. The twins are connected at the abdomen and share the same digestive tract, so separating them was impossible.
Cases of conjoined twins occur not only in humans. True, the chance of meeting such twins in nature is small: these animals are weak and quickly become victims of predators. Therefore, in natural science museums we can most often see stuffed animals or preparations of two-headed mice, six-legged calves and other domesticated animals.
Conjoined twins are one of the rarest and most severe types congenital anomalies that pediatric surgeons have to deal with. In the distant past, twins born conjoined were considered “monsters” and “freaks.” Currently, such twins, if there is a favorable anatomical variant of the connection, can be separated, which allows each of them to subsequently lead a completely normal life.
In Greek mythology, it was believed that twins born conjoined were the result of human intercourse with animals. Pliny, a Roman statesman, said that “nature creates monsters to surprise us and for her own amusement.” Ambroise Paré, an outstanding surgeon of the 16th century, in his treatise On Monsters and Miracles, described 11 reasons for the appearance of such twins.
In the 18th century, Smelley suggested the introduction of two or more sperm into a single egg as the cause of the development of "twin monsters." In the late 19th century, Simpson proposed that conjoined twins were the result of the fusion of two identical twins.
The earliest published case is that of conjoined twins (girls) Biddenden, born in England in 1100. The twins were joined at the hips and lived to be 34 years old. After the death of one, the other, refusing to separate, died 6 hours later. But the most famous conjoined twins were, of course, Eng and Chang Bunker, born in Siam in 1811.
Although they were known as Siamese twins, their mother was half Siamese and half Chinese, and their father was a purebred Chinese. The twins were joined at the epigastric region by a tissue cord measuring 3.5 inches (about 9 cm) in diameter and 7.5 inches (about 19 cm) in circumference. Throughout their lives, they were the subject of constant interest for doctors who found out whether it was possible to separate them. R. T. Barnum, taking advantage of the incredible popularity of conjoined twins, began to exhibit twins in his show. Unfortunately, this is where the tradition of turning conjoined twins into circus freaks came from, putting them on display.
However, as a result of these performances, Eng and Chang became very wealthy and then retired to a farm in North Carolina, where they had a total of 22 children. On January 12, 1874, at the age of 63, Chang fell ill with bronchitis and died. Eng died 6 hours later. Although it was believed that Eng died of fear, most likely he died as a result of blood loss, that is, a “transfusion” of his blood through the common liver into the vascular bed (with reduced vascular resistance) of his deceased brother. The tissue cord that connected the twins, having a very simple structure, consisted mainly of muscles with a thin isthmus of liver tissue. They, of course, could be separated, and even more so after Chang's death.
Frequency and embryology. Twins (regular, unconjoined) are born with a frequency of approximately 1 in 87 newborns, and one third of them are identical twins (monozygotic). The birth rate of monozygotic twins, being fairly constant, is 4 per 1000, while the birth rate of fraternal (dizygotic) twins varies depending on the age of the mother, amounting to approximately 10 per 15 thousand births.
As for conjoined twins, they are born with a frequency of 1: 50,000 to 1: 100,000 newborns. Monozygotic boy twins are born much more often than monozygotic girl twins, but among conjoined twins, 70% are girls. At the same time, according to the literature, boys predominate among stillborn conjoined twins.
Identical twins develop as a result of the division of a single fertilized egg, fraternal - as a result of the fertilization of two separate eggs. Monozygotic twins thus always have the same sex, a single chorionic sac and a single placenta. In addition, each fetus has its own amnion, yolk sac and umbilical cord. As for dizygotic twins, they can be of the same sex, but there are also opposite sexes, each of them has its own chorionic sac, and there are two placentas.
In 1948, it was found that by the 6th day after fertilization, a cluster of human zygote cells turns into a blastocyst. At one pole of the blastocyst, several cells come together to form what is called the inner cell mass. From it the embryo, amnion and yolk sac develop. On early stage within a short period of time, the cells of the inner cell mass are totipotent and can split to form two germ disks that develop into two identical twins.
The separation of the zygote within the first 7 days after fertilization results in the appearance of monozygotic identical twins. Conjoined twins are the result of incomplete division of the inner cell mass into more late dates- approximately between the 13th and 16th days after fertilization.
It remains unclear why cleavage after day 7 is associated with a greater likelihood of developing complex fusion species. It has been established that this incomplete division is caused by the suppression of processes that normally ensure the formation of the organ, preventing its complete division. Thus, as a result, fused organs are formed: heart, liver, gastrointestinal tract.
Classification. There are many classifications of conjoined twins, but in clinical practice Potter's classification is the most frequently and widely used. Most summary reviews of this pathology are limited to the analysis of symmetrical and equivalent twins. According to this classification, the name of conjoined twins consists of a word denoting the place where they are joined, and the Greek root pagus, meaning that it is in this place that the twins are joined (Table 76-1).
Table 76-1. Classification of conjoined twins and the frequency of their various types
Accordingly, conjoined twins are divided into thoracopagus (fusion site - chest), omphalopagus (abdomen), ischiopagus (pelvis), pygopagus (sacrum) and craniopagus (skull). The most common births (40% of all conjoined twins) are thoracopagus, with omphalopagus accounting for 33%, pygopagus - 19%, ischiopagus - 6% and craniopagus - 2%. In some classifications, thoraco- and omphalopagus are combined into one group - thoracoomphalopagus, the frequency of which is 73%.
Thoracopagi. Thoracopagus face each other. The length of the connection may vary, but in any case it is limited above by the suprasternal notch and below by the umbilicus (Fig. 76-1). They usually share a chest wall, sternum, diaphragm, and upper abdomen. In most cases, fusion (to one degree or another) of the pericardium is also noted. About 75% of thoracopagus are conjoined and the hearts are usually “vicious.”
Although the connection of the thoracopagus seems to be limited to the chest wall, there is often fusion to the liver as well. At least 50% of these twins have a connection of the digestive tracts and 25% have a single (for two) external bile ducts.
Omphalopagus. Omphalopagi, also known as xifopagi, face each other and connect in the epigastric region without significant involvement in the fusion of the chest. Typically, such twins are also connected by the abdominal cavities and liver. Although the upper intestinal tracts are usually different for each of them, however, a common terminal ileum may be noted, as well as a common large intestine.
One of the twins has an imperforate anus. In addition, the bladders can be connected by non-closed urachus through a connective tissue cord. There is often a hernia of the umbilical cord. If the membranes of the omphalocele rupture, emergency surgical separation of the twins may be necessary.
K.U. Ashcraft, T.M. Holder
It is common knowledge that there are two types of twins. Dizygotic (fraternal or fraternal, non-identical) twins develop from two or more simultaneously fertilized eggs. Monozygotic (identical, identical) twins - from one fertilized egg, at an early stage of development split into two (three, four ...) parts. On average, this occurs in three to four pregnancies out of a thousand. The reasons for this splitting have not yet been precisely established. Monozygotic twins are genetically identical. From a geneticist's point of view, dizygotic twins are ordinary brothers and sisters.
Depending on the stage of development of the fertilized egg, its splitting occurred, several types of development of monozygotic twins are distinguished:
1. In very rare cases (1% of all monozygotic twins), splitting occurs quite late, when the amniotic bladder and chorion have already formed. Then the twins develop in a common amniotic membrane and with a common placenta (monochorionic and monoamniotic type).
2. If the splitting of the zygote (fertilized egg) occurs later, when a hollow ball is formed from the dividing cells, then the twins share the chorion and placenta, and their amniotic membranes are individual. This is the most common option- it occurs in approximately two-thirds of cases of development of monozygotic twins (monochorionic and diamniotic type).
3. After fertilization, any egg, regardless of whether it is destined to “give birth” to twins or a single fetus, begins to actively divide. The cells formed during this fragmentation of the egg are called blastomeres. Blastomeres do not grow, but only decrease by half with each subsequent division. So, splitting can occur already at the stage of two (several) blastomeres and follow an “individualistic” path. By “individualism” we mean the following: identical embryos develop from these blastomeres (after all, they are “children” of the same egg), but each has its own chorion and amniotic membrane (dichorionic diamniotic type). About a third of all monozygotic twins develop this way. In this case, there is most often one placenta, but it happens that “individualism” goes so far that even two placentas are formed (or several if there are more than two fetuses).
A unique operation to separate conjoined conjoined twins from Iran, Ladan and Laleh, which lasted more than two days, ended unsuccessfully. Both patients died from blood loss. First Ladan died, and a few hours later Laleh followed her sister into the next world.
The doctors did not hide the fact that even with the most favorable outcome, the women would have to undergo long-term rehabilitation. At its first stage, they could encounter side effects “mental and physiological effects that they have never experienced in their lives.”
Separating the 29-year-old sisters, 28 surgeons and 100 assistants first destroyed the bony partition between their skulls, after which they created a bypass for the blood feeding the women’s brains - Ladan and Laleh had one cerebral vein between them. Then the doctors “supplied power” to the brains of each of the women - one of them had to implant a vein taken from the thigh - and began to actually separate the brains. This stage of the operation, considered the most difficult (the slightest mistake could cause irreversible consequences), began the night before.
"The brains were very much fused. Neurosurgeons literally had to separate them millimeter by millimeter," Dr Prem Kumar said at a press conference at Raffles Hospital, where the operation took place. After the sisters were finally separated, plastic surgery specialists got down to business.
Let us recall that Ladan and Laleh Bijani sought permission for the operation for 7 years, although they knew very well what they were facing - doctors for a long time They did not dare to take on such a difficult case. Siamese twins are usually separated into early childhood, and surgeons had not previously dealt with patients with fused heads. The risk that at least one of the women would not survive was extremely high.
Ladan and Laleh were born into a poor family with 11 other children. Despite the physical defect, the Iranians managed to graduate from the University of Tehran, although the learning process took 6 and a half years instead of 4 years. Ladan dreamed of becoming a lawyer, and Laleh dreamed of becoming a journalist. In addition, the sisters drove the car themselves. Friends of the sisters claimed that the women had completely different characters.
The operation cost the Iranian government $300 thousand. It was done in Singapore, since conjoined twins from Nepal Ganga and Jamuna were successfully separated at Raffles Hospital last year.
The whole world was shocked by the unsuccessful end of the operation to separate Siamese twins. In this regard, we decided to conduct a small study on the performance of operations to separate conjoined twins.
Since the 10th century, about 200 operations have been performed to separate conjoined twins. First good try was undertaken in 1689 by the German surgeon Koenig - he separated twins joined at the waist. Despite centuries of experience in carrying out such operations, each of them remains unique and is associated with significant risk.
Two hands, two heads, two hearts... Is it impossible to separate them? Now in most cases this succeeds, but if the twins have a common vital important organs, such as the heart or liver, surgical intervention impossible.
The most famous of these operations was carried out on Raditza and Doditsa, Siamese sisters born in 1888 in the Indian state of Orissa. They were connected chest and bellies.
In 1893, a London impresario began showing girls in the circus. Then, in 1902, they became the main attraction of an exhibition organized by the French Academy of Medicine. It was there that doctors discovered that Doditsa was sick with tuberculosis. To save the sister's life, they decided to separate them. An exceptionally complex operation was performed by Dr. Dowan. But it soon became clear that the operation was unsuccessful. However, her main goal - extending Raditsa's life - was achieved, since she outlived her sister by two whole years.
Now operations are quite successful in most cases. Only craniopagus (fused heads) possibilities modern medicine They don't always allow you to separate.
The first successful operation to separate conjoined twins was performed on December 14, 1952 at Mount Sinai Hospital, Cleveland, PC. Ohio, USA, Dr. Jacques S. Geller.
In Lithuania, in the city of Alytus, live twelve-year-old girls, Viliya and Vitalia Tamulevichus, who from birth were doomed, if not to death, then to a terrible life... If not for the director of the Moscow Institute of Neurosurgery. Burdenko academician Alexander Konovalov. Ten years ago, he performed the first operation to separate twins who were fused not only with their foreheads and tops, but also with their brains! The girls' faces were in different planes, one turned away from the other at an angle of approximately 90 degrees. In total, the twins endured more than 20 complex operations. Girls grow up cheerful, talkative, study successfully and love to read. And most importantly, like all twins, they cannot live without each other for even an hour.
On average, after operations to separate Siamese twins, only one in four survives. Moreover, surgical intervention is considered successful even if one of the patients dies.
When conjoined twins are born sick, doctors and relatives face a difficult ethical problem. Sometimes only one twin has a chance to survive, and for this you need to sacrifice the life of the second twin. Parents may choose to surgically separate twins and save the life of the strongest twin. A similar incident occurred in 1993 with Emmy and Angela Lakeberg.
The sisters were born fused from the chest to the abdomen; they shared a liver and a deformed heart. Their mother, Rita Lakeberg, knew she was carrying conjoined twins who had little chance of surviving and considered aborting, but in the end said, "I can't get rid of my babies." The twins were born so weak that doctors wanted to immediately turn off the air supply that kept them alive.
But the Lakebergs found a clinic in Philadelphia where surgeons undertook to separate the sisters in the hope that they could operate on the deformed heart to save the life of one of them. Angela had a better chance, but still, she had less than a 1% chance of surviving.
The operation lasted five and a half hours, Emmy did not live two hours before its completion. Angela's condition after the operation was stable, but 10 months later, right before her first birthday, she also died.
Rita Lakeberg closed her eyes financial side problems and explained: "I could not live on, torturing myself with the question of whether it was possible to save the life of one of the twins." But the public questioned whether such costly surgeries should be carried out when the chances of success are so low, and many people cannot get basic medical care due to a lack of funds.
In addition, operations of this kind are contrary to the main provision of the Hippocratic oath, namely "do no harm." The experts pointed to the fact that if the twins were not fused, in the event of illness of both, no one would offer to sacrifice one of the sisters and transplant her internal organs to the second. It has been suggested that the public does not mind drastic measures being taken on conjoined twins simply because many perceive them to be monsters.
But there is another point of view on the operations to separate Siamese twins - they are seen as the last opportunity to save a person's life. When fused twins Christina and Betsy Woden were born in 1973, doctors separated them, and Betsy died of a heart defect. Christina is still alive and well to this day. Their mother, Jeanne Walzek, said: “They had to be separated, so what happened was what had to happen. The strongest will survive, the weak may not, but that's the way it is: sometimes you have to sacrifice something to save someone's life.
Most often, Siamese twins are female (70-75% of cases).
These twins were named “Siamese” in honor of the famous brothers Chang and Eng Bunker, born in Siam (modern Thailand) in 1811. The brothers were connected to each other in the chest area.
Religious ministers declared them harbingers of the end of the world, and the king of Siam signed their death warrant, which was literally miraculously overturned later.
Their mother flatly refused to try to separate the brothers, fearing that this could lead to the death of one of them. She rubbed their skin special creams, to give elasticity to the tissues connecting the twins, and ensured that Eng and Chang were able to not only stand face to face, but change their position more or less freely.
Despite the fact that their appearance frightened the locals, the brothers brought glory to their country. Eng and Chang were the first conjoined twins to actively travel and appear in public. They were accepted by many royal courts, with the exception of France, which did not even allow them to cross the border.
In 1839, the Bunker brothers decided to leave show business and settled in North Carolina (USA), where they successfully farmed. In 1855, the brothers married sisters Adelaide and Sarah Ehn, who were not twins. The first couple had eleven children, and the second had ten.
In 1874, at the age of 62, Chang died in his sleep, followed three hours later by his brother Eng.
Twins Rita and Cristina Parodi were born on March 3, 1829 in Sardinia. They possessed separate upper bodies, but only one pair of legs.
Their parents brought them to France in the hope of making a fortune from their abnormal offspring. But they were unable to obtain permission to speak publicly. The twins constantly suffered from colds. Rita, who was very ill from birth, weakened before her eyes and died on November 23, 1829 while breastfeeding. Christina, who had been strong and healthy until that moment, died a few seconds later. They lived only 8 months.
The twins' skeleton, as well as a plaster cast of their bodies, is currently in the possession of the Natural History Museum in Paris.
In 1878, sisters Rosa and Josepha Blazek, joined at the buttocks, were born in Bohemia. The relatives thought it would be better if they died, and after birth they did not feed them for several days. However, the girls stubbornly clung to life. And when they grew up, they proved that it was not for nothing that they ate their bread. Already in 1892, they became famous on both sides of the Atlantic, captivating audiences with their virtuoso playing of the violin and harp.
On April 15, 1910, the sisters were admitted to the hospital because Rosa’s belly had grown greatly. Josepha's condition was normal. Both vigorously denied the possibility of pregnancy, defending their maiden honor. But pregnancy is difficult to hide, and on April 17 a healthy boy was born.
By that time, Rose admitted that she had a lover and named him. He tried to rectify the situation by proposing marriage. This caused a lively debate in the press. Some wrote that sisters should have the same husband because they are anatomically connected. Others believed that since they had two hearts and different affections, they should have two husbands. The dispute was academic, because the laws of none of the American states had a corresponding act. And Rose's lover soon disappeared.
The Filipino pair of twins Lucio and Simplicio Godina, fused at the seat area, also gained great fame. They were born in 1908 in the Philippines and successfully performed on stage as dancers. Married twin sisters who joined the family room. When Lucio fell ill with pneumonia and died in 1936, Simplicio was immediately and quickly separated from him. However, a few days later he also died.
The most famous Siamese sisters were Daisy and Violet Hilton, also born in 1908 in England. Joined thighs beautiful girls played one of the main roles in the film “Cripples” by Tod Browning. In 1937, they were earning $5,000 a week and their novels were front-page material.
One day, tired of an endless chain of novels, Violetta decided to marry dancer James Moore. They formalized their marriage in Texas. However, after a couple of weeks, both demanded a divorce. In 1941, Daisy tried marriage, but her union was equally short: ten days after the ceremony, her husband disappeared.
The tradition of performing on the stage was continued by Margaret and Mary Gibb, joined at the buttocks. They were born in the USA on May 20, 1912, and loved each other incredibly all their lives. They could be separated with minor surgery, but the sisters didn't want to hear about it. “We were born this way, we will die this way,” they habitually answered. On January 17, 1967, Margaret died of cancer, followed by her sister.
Masha and Dasha Krivoshlyapov were born in Moscow on January 4, 1950 to Ekaterina and Mikhail Krivoshlyapov. The sisters were born with two heads, four arms and three legs. Their dorsal ridges were connected at an angle of 90 degrees. Catherine was first told that her daughters had died, and after a while the compassionate sister showed her the girls. After this, the woman began to have mental problems. Mikhail Krivoshlyapov was Lavrentiy Beria’s driver at that time. Under pressure medical management he signed the death certificate of his daughters and did not want to know anything more about them.
Medicine could not miss the opportunity to study such a rare case. For 7 years at the Institute of Pediatrics of the Academy of Sciences of the USSR, they were studied by physiologist Pyotr Anokhin.
Then they were placed in the Central Research Institute of Traumatology and Orthopedics, where their third leg was amputated. There the girls were taught to walk with crutches and given a primary education.
For almost 40 years, the twins lived in Soviet institutions for the disabled. Shortly before their death, at the invitation of a French company, they visited Paris.
Masha and Dasha Krivoshlyapov died on April 13, 2003 at the First City Hospital in Moscow. Masha was diagnosed with acute heart attack. For half an hour, intensive care doctors tried to “start” the stopped heart. 17 hours after Masha's death, Dasha died of intoxication.
Some historians believe that the images of the Roman god Janus, who had two faces, or the mythological hero of the Centaur, could well be inspired by the legends of the Siamese twins.
The Mutter Museum in Philadelphia holds one of the first documented accounts of the Biddend Maidens.
Sisters Mary and Eliza, connected at the hips, were born in 1100 in Biddend, Kent. At the age of 34, one of the sisters dies, the second is offered an emergency operation, but she refuses with the words: "We came into this world together, we will leave it together."
She followed her sister a few hours later. This story has been preserved thanks to the local church, which, having received 20 acres of land after the death of the sisters, still distributes cookies with the image of Mary and Eliza to parishioners every Easter.
However, not all conjoined twins have such a tragic fate. For example, sisters Abigail and Brittany Hensel are ten-year-old conjoined twins who, while physically remaining one, live a completely normal, full life.
They are dicephalic twins, having one torso, two arms, two legs and three lungs. Each has its own heart and stomach, but the blood supply between them is common. The two spinal cords end in one pelvis, and they share all the organs below the waist. Such twins are very rare. The archives record only four pairs of surviving dicephalic twins.
Each sister controls the arm and leg on her side, and each feels touch only on her side of the body. But they coordinate their movements so well that they can walk, run, ride a bike and swim. They learned to sing and play the piano, with Abby playing the parts with her right hand and her sister with her left.
The girls live in a small town in the western United States with their mother, a nurse, father, a carpenter, and younger brother and sister. The family runs a farm with five cows, a horse, three dogs and many cats. People living in the same town treat them completely normally, and rudeness from strangers is simply ignored. The sisters explain to the curious that they “don’t have two heads,” but that they are, in fact, two different people. This is emphasized by their clothes, which are bought in a regular store and then altered to create two necklines.
They have different tastes, interests and personalities: Abby hates milk, and Britty loves it. When they eat soup, Britty won't let her sister put crackers on her half. Abby is more aggressive, Britty is more artistic. Abby is better at math, and Britty is better at spelling. When they need to coordinate their desires and make a decision, they flip a coin, set the order of the desired actions, or ask their parents for advice. They usually resolve differences through compromise, but this is not always possible. There are disputes and even light fights between them. One day, when they were very young, Britty hit Abby on the head with a rock.
They often seem to be able to read each other's thoughts (some doctors explain this by the fact that certain parts of their nervous system intersect with each other). When Britty coughs, Abby automatically covers her mouth with her hand. One day they were watching TV and Abby said to Britty, “Are you thinking the same thing I'm thinking?” Britty replied, “Yes,” and they went into the bedroom to read the same book.
Their parents tell them, “You can do whatever you want.” Both want to become doctors when they grow up. Britty says she wants to get married and have kids.
Another pair of conjoined twin sisters, each of whom is quite happy with life and does not lose heart, are Laurie and Dori (nicknamed Reba) Shappel, born in Reading, Pennsylvania, in 1961. They are fused together by an area of the skull and scalp, and they share a common blood supply to the brain. Reba is paralyzed from the waist down, and Laurie carries her in a special chair. These twins look in different directions and perhaps therefore see life from different perspectives: Lori is outgoing, Reba is shy; Laurie loves TV, shopping, and candy, but Reba does not. Lori cuts her hair short and Reba dyes it golden color and wears curls.
Each of the sisters has their own career. Laurie worked as a clerk and as a receptionist. Reba dreams of becoming a country singer. Her special achievements were recognized music program awards awards in Los Angeles, which is dedicated to supporting young performers. Program Manager Alfred Bowman expressed his admiration for her talent and ability to perform under such difficult conditions.
Geminis believe that in many ways they are the same as everyone else. They worked out effective ways non-interference in each other's personal lives. They usually devote themselves to Laurie's career; but now Laurie is working part-time, and Reba will have more time to develop her talents. When Reba sings in the studio or in concert, Lori becomes passive and lets her sister do her thing.
On the other hand, Laurie wants to get married and have children. And in order to allow Laurie to have a private life, Reba becomes quiet and mentally carried away, so although she is physically here, she is really absent. “The young man gets used to it,” Laurie says. “If he wants to be with me, he has to get used to the fact that she is always there.”
And some information about the recently born conjoined twins...
03.10.2001 Doctors in the city of Shanghai encountered a rare case in medical practice. They discovered the embryo of “Siamese twins” in the abdominal cavity of a newborn premature girl.
Immediately after the birth of the child, doctors discovered an unknown “solid formation” in her stomach. The CT scan made it possible to clarify what it really was.
After a successful operation, the fetus of “Siamese twins” with fused spines was removed from a five-day-old girl.
According to experts, the girl's mother was pregnant with triplets. However, for a number of reasons that are still being specified, two of the three fetuses began to develop in the womb of the third child.
07/12/2002 Two Siamese twin girls were born in the Kirovograd regional hospital. The doctor on duty at the pathology department of the regional children's hospital, Vladimir Kolod, said that the newborns are in his department.
According to Kolod, this is the first case of the birth of conjoined twins in his medical practice. “For 30 years, this is the first case for me,” he said.
According to the Committee of Voters of Ukraine, the birth of Siamese twins in Kirovograd is the first case in the history of independent Ukraine. The twins are fused with their bellies and chests. The total weight of the twins is 5 kilograms 300 grams.
06/23/2003 Unique Siamese twin girls were born in the Argentine city of San Juan: they have a common heart, common lungs and genitals, but two heads, stomachs and spines. At the same time, a completely healthy boy was born along with the twins. Doctors believe that this case has no analogues in world practice.
C-section, which allowed newborns to be born to a 25-year-old woman from their poor family, was produced at the Rawson Maternity Hospital. Director medical institution Gonzalo Medina said he could not say anything about the future of the conjoined twins, “although so far they are developing well.”
“Although all metabolic and physiological functions in girls operate within normal parameters,” Medina said, he and 23 other doctors involved in unusual births and caring for newborns believe that “any attempt to separate twins is incompatible with preserving their lives."
To summarize, we can come to the conclusion that conjoined twins have a lot in common with other twins. They have a close emotional connection, which is further enhanced by the fact that their bodies are connected. And like other twins, conjoined twins need to overcome the limitations imposed by this connection - they need to develop their own tastes and talents and become individuals. As seen from the above a short excursion throughout history, many succeeded and they lived and live full, interesting lives.
Zita and Gita Rezakhanov (born October 19, 1991, Zapadnoye village, Sokuluk district, Chui region, Kyrgyzstan) are Siamese twins from Kyrgyzstan, Russian-speaking Lezgins by origin].
They gained fame in the Russian media after 2003, when Russian doctors at the Filatov Central Children's Clinical Hospital in Moscow performed a successful operation to separate the sisters. The peculiarity of the operation was that the Rezakhanovs were ishiopagus, just like the Krivoshlyapov sisters. This is a fairly rare variety of Siamese twins, accounting for about 6% of their number. They had three legs for two and a common pelvis that needed to be divided. The missing leg was replaced by a prosthesis. The girls spent 3 years in Moscow. Despite their mother's attempts to obtain Russian citizenship for them, the girls returned to Kyrgyzstan. They participated several times in Andrei Malakhov’s show “Let Them Talk” last time having flown there from Kyrgyzstan on February 12, 2010 to participate in an episode dedicated to discussing abortion according to medical indications about the condition of the fetus.
Girls who do not dream of being separated make big plans for the future: go to college, get married and have children...
