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

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.