Imaging of liver fusion and vascular intra-hepatic shunts in omphalopagus conjoined twins: The role of a double CT study

Publication date: Available online 22 November 2018

Source: Clinical Imaging

Author(s): Antonino Barletta, Marina Pace, Lorenzo D'Antiga, Maurizio Cheli, Giovanna Mangili, Sandro Sironi

Abstract

Omphalopagus twins are joined ventrally in the umbilical region. In omphalopagus twins, liver's fusion is very frequent, being present in about 80% of cases. Two conjoined twins born in our Hospital were evaluated using plain x-rays, ultrasound (US), gastrointestinal xrays, Tc-99 hepatobiliary scintigraphy (SC) and contrast enhanced computed tomography (CT). There was no bony connection on conventional xrays, neither bowel communication on GI x-rays study. US demonstrated the fusion of left hepatic lobes and a not-quantifiable vascular shunt.

Normal biliary function was demonstrated by Tc-99 SC. The first CT scan (twin A) showed irregular lobules in the site of hepatic fusion, a portoportal shunt and a venous vessel to the inferior vena cava of twin B. Only the second CT scan (twin B) showed an arterio-arterial partiallyextrahepatic shunts. The double CT scan allows to increase the probability of a correct individuation and description of vascular shunts for an effective preoperatory assessment. The omphalopagus twins in our case underwent planned surgical separation at 5 months of age. The surgery lasted 5 h and was not affected by any intraoperative complications.

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