Can Siamese twins grow together? Siamese twins - one life and one body for two

Since the 10th century, about 200 operations have been performed to separate conjoined twins. The first successful attempt was made 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.

But the goal was achieved

Two hands, two heads, two hearts... Isn’t it possible to separate them today if a successful operation was carried out at the end of the 17th century? However, medical historians believe that the German surgeon Koenig achieved success only because the twins were conjoined only skin, like subcutaneous connective tissue and fatty tissue in the waist area. Now the separation of twins is possible in many, but by no means in all cases, and if the twins have common vital organs, such as the liver, surgical intervention impossible.

The most famous of this type of operation was performed on Raditz and Doditz, Siamese sisters born in 1888 in the Indian state of Orissa. They were connected by their chests and stomachs. 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 with heads) are not always able to be separated by the capabilities of modern medicine.

The first successful operation to separate conjoined twins who were fused at the head, but each had their own brain, was performed on December 14, 1952 at Mount Sinai Hospital, Cleveland, PC. Ohio, USA, Dr. Jacques S. Geller.

Only one in four survives

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 of the Russian Academy of Medical Sciences Alexander Konovalov. Ten years ago, he performed the first operation to separate twins who were fused not only with their foreheads and tops of their heads, 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 conjoined 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 families face a difficult ethical dilemma. Sometimes only one twin has a chance to survive, and to do this, you need to sacrifice the life of the other twin. Parents may choose to surgically separate the twins and save the life of the stronger twin. A similar incident occurred in 1993 with Emmy and Angela Lakeberg.

Probability less than 1%

But the Lakeburgs found a clinic in Philadelphia, where surgeons undertook to separate the sisters in the hope that it would be possible to operate on the deformed heart to save the life of one of them. Angela had a better chance, but still, the probability that she would survive was less than 1%.

The operation lasted five and a half hours, Emmy did not live two hours before its completion. Angela's condition was stable after the operation, but 10 months later, right before her first birthday, she also died.

In addition, operations of this kind contradict the main provision of the Hippocratic oath, namely “do no harm.” Experts pointed to the fact that if the twins were not conjoined, if both were ill, no one would suggest sacrificing one of the sisters and transplanting her internal organs second. It has been suggested that the public does not object to drastic measures being taken against conjoined twins simply because many perceive them as monsters.

But there is another point of view on operations to separate conjoined twins - they see them as the last opportunity to save a person’s life. When conjoined 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 Walzeck, said: "They had to be separated, so what had to happen happened. The strongest will survive, the weak may not, but that's the way it is: sometimes you have to sacrifice something to save someone else's life." life".

To operate or not?

In 1990, Lev Borisovich Novokreshchenov, head of the Department of Pediatric Surgery, Orthopedics and Traumatology at the Chelyabinsk Medical Institute, did not face a dilemma at all - to perform or not to perform an operation. After, according to an ultrasound examination, it became known in the city ahead of time that a young woman, an employee of one of the Chelyabinsk factories, was about to give birth Siamese twins, Novokreshchenov knew for himself: of course, he would try to separate the children. And how could it be otherwise? This will have to be done as soon as possible, as soon as circumstances allow: every extra hour of nature’s tragic mistake will bring unnecessary suffering to both the mother of the twins and the babies themselves.

They may ask why they waited 36 days without having this operation done earlier, if they were preparing for it and decided on it a long time ago? A non-healing wound in the navel area was in the way. Instinctively, the poor children kept trying to push away from each other, and the wound got worse. When surgeons attending children realized the futility of conservative efforts, they took babies for surgery with this powerful risk factor.

Loops of intestines were discovered through a significantly stretched band of white pine and the parietal peritoneum of the “bridge”; a pleasant surprise was the discovery during the operation of a kind of septum between the abdominal cavities of the twins from the liver to the navel. It was as if nature itself tried to at least partially correct its monstrous mistake by creating this partition in the form of two thin petals, which became a guiding line for surgeons.

Now the question arose of how exactly to divide the liver. The babies' weight at birth was 4700, at the time of surgery - 5800 grams. It seemed rude and blasphemous to use the widely used Vietnamese method when dividing the liver, in which the surgeon actually tears the body of the liver with his fingers, exposing, like strings, the vessels and bile ducts. Novokreshchenov used a thinner instrument - a hemostatic curved Billroth forceps. There were other successful tactics.

The surgeon believes that the team was lucky: there was no threat to the babies’ lives during the operation. Everything happened under careful monitoring.

Who are Craniopagus?

In 2001, British surgeons successfully separated conjoined twins who were fused at the base of the spine. According to the doctors from Birmingham who performed this operation, it was only the third such operation in the world. Now the separated patients, now teenagers, are doing well.

Conjoined twins Eman and Sanchia were born at Birmingham Children's Hospital. They were connected not only by a section of the spine, but also by part of the intestine. However, during a 15-hour operation, surgeons managed to separate the twins without any visible complications.

The majority of the surgical team was local, but they worked with the assistance of Lewis Spitz of Great Ormond Street Children's Hospital in London, who is the world's leading authority on conjoined twins. Surgeons had to separate the spinal cord. In addition, doctors were faced with the need to divide the intestine. They also had to deal with the problem of not having enough skin to cover the defect created after the separation. To do this, a few weeks before the operation, skin-stretching balloons were placed and inflated under the twins' skin.

In 2002, an operation to separate the fused skulls of sisters Maria Teresa and Maria de Jesus Quich-Alvarez was performed at the University of California at Los Angeles clinic and lasted more than 20 hours. They say their theoretical chance of survival was one in a million. However, everything went well. Perhaps the most severe manifestation of craniopagia is the situation when two separate brains of twins have common vessels. When surgeons divide the vessels of the skull, serious circulatory problems can occur in the brain, most dangerous in adult patients. In children, the brain tolerates such complications much more easily.

It is also important for doctors to determine how connected the twins' circulatory systems are. To do this, one of them is injected into a vein special substance, the path of which through the vessels is traced using an X-ray machine. The screen shows at what speed the substance moves from one twin to the other, and which vessels are involved in this process.

By determining the speed of movement of the same substance through the vessels of each of the twins, it is possible to assess how efficiently their hearts work and whether they are able to provide an autonomous blood supply to their bodies after separation. The speed and efficiency of removal of the radiopaque substance from the body allows us to judge the functioning of the kidneys.

The proportion of craniopagus among all conjoined twins is no more than 6%. This pathology occurs when an embryo, giving rise to two identical embryos, does not completely diverge. This process occurs in the second week of pregnancy. The skulls of twins are most often fused in the parietal region; occipital and frontal fusions are also common.

The most successful operations are to separate twins in whom a small amount of common vessels and no defects of the meninges. In this case, the fusion of two different skulls occurs only in a small area.

Most often, complications occur in the case of so-called complete craniopagus. A tomogram of the skull of such twins shows a single cranium containing two brains. However, even with a large area of fusion, a positive outcome of the operation is possible, provided that the twins have few common vessels.

The surgical technique for dividing and replacing the skull defect is selected individually in each case of craniopagia. Sometimes doctors even resort to complete cardiac arrest, artificial circulation and lowering the body.

Kirillov Vadim

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 during the embryonic period of development and share common body parts and/or internal organs. The likelihood of such people being born is approximately one in 200,000 births. More often than not, conjoined twins are born girls, although the first two sets of the most famous conjoined twins were born boys. But if you 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 conjoined twins was scientifically recorded and dated back to 945. This year, two conjoined boys from Armenia were brought to Constantinople for examination by doctors. 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 conjoined twins. Unfortunately, the second brother also did not survive.

2. Chang and Eng Banker

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 Mary Hilton's death, her relatives began to “look after” 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 Violet 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 ensured they were well educated. 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 elderly people. IN last years Throughout their lives, Masha and Dasha often drank.

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 - shining example the fact that, while remaining a single whole, you can live a completely normal, 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 a lot of friends loving parents and a completely 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.

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.

Two hands, two heads, two hearts... Is it impossible to separate them? Now this is possible in most cases, but if the twins share vital organs such as the heart or liver, surgery is not possible.

The most famous of this type of operation was performed on Raditz and Doditz, Siamese sisters born in 1888 in the Indian state of Orissa. They were connected by their chests and stomachs.
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 with heads) are not always able to be separated by the capabilities of modern medicine.

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 of their heads, 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 conjoined twins, only one in four survives. Moreover, surgical intervention is considered successful even if one of the patients dies.

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 with little chance of survival and considered abortion, but finally 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 was keeping them alive.
But the Lakeburgs found a clinic in Philadelphia, where surgeons undertook to separate the sisters in the hope that it would be possible to operate on the deformed heart to save the life of one of them. Angela had a better chance, but still, the probability that she would survive was less than 1%.
The operation lasted five and a half hours, Emmy did not live two hours before its completion. Angela's condition was stable after the operation, but 10 months later, right before her first birthday, she also died.

Rita Lakeberg closed her eyes to the financial side of the problem and explained: “I could not live further, tormenting myself with the question of whether it was possible to save the life of one of the twins.” But the public has questioned whether such expensive surgeries should be carried out when the chances of success are so low, and yet many people cannot receive basic medical care due to a lack of funds.
In addition, operations of this kind contradict the main provision of the Hippocratic oath, namely “do no harm.” Experts pointed to the fact that if the twins were not conjoined, if both were ill, no one would suggest sacrificing one of the sisters and transplanting her internal organs into the second. It has been suggested that the public does not object to drastic measures being taken against conjoined twins simply because many perceive them as monsters.

But there is another point of view on operations to separate conjoined twins - they see them as the last opportunity to save a person’s life. When conjoined 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 Walzeck, said: “They had to be separated, so what had to happen happened. 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.”

A unique operation to separate conjoined twins was carried out in Chelyabinsk.

Lev Borisovich Novokreshchenov, head of the Department of Pediatric Surgery, Orthopedics and Traumatology at the Chelyabinsk Medical Institute, did not have a dilemma at all - to perform or not to perform the operation. After, according to an ultrasound examination, it became known in the city ahead of time that a young woman, an employee of one of the Chelyabinsk factories, was going to give birth to Siamese twins, Novokreshchenov knew for himself: of course, he would try to separate the children. And how could it be otherwise? This will have to be done as soon as possible, as soon as circumstances allow: every extra hour of nature’s tragic mistake will bring unnecessary suffering to both the mother of the twins and the babies themselves.
They may ask why they waited 36 days without having this operation done earlier, if they were preparing for it and decided on it a long time ago? A non-healing wound in the navel area was in the way. Instinctively, the poor children kept trying to push away from each other, and the wound got worse. When surgeons who regularly see children realized the futility of conservative efforts, they took babies for surgery with this powerful risk factor.

The operation lasted one hour and forty-five minutes and went surprisingly smoothly. Well, what about emotions? There was composure, a desire for success, and great pity for the children. And, of course, scientific interest and scientific pride. Through careful preliminary research, we have established that conjoined twins (more precisely, I would call them unseparated) have a common liver with two independent bile collectors, independent gastrointestinal tracts, urinary systems and cardiopulmonary complexes. And under endotracheal anesthesia (fluorotane, nitrous oxide, calypsol, oxygen) with controlled breathing of both twins (muscle relaxation with ditilin), a skin incision was made along the midline of the connecting “bridge” and along the entire length of its anterior surface with the intersection of the common xiphoid process.
Loops of intestines were discovered through a significantly stretched band of white pine and the parietal peritoneum of the “bridge.” A pleasant surprise was the discovery during the operation of a kind of septum between the abdominal cavities of the twins from the liver to the navel. It was as if nature itself tried to at least partially correct its monstrous mistake by creating this partition in the form of two thin petals, which became a guiding line for surgeons.
Now the question arose of how exactly to divide the liver. The babies' weight at birth was 4700, at the time of surgery - 5800 grams. It seemed rude and blasphemous to use the widely used Vietnamese method when dividing the liver, in which the surgeon actually tears the body of the liver with his fingers, exposing, like strings, the vessels and bile ducts. Novokreshchenov used a thinner instrument - a hemostatic curved Billroth forceps. There were other successful tactics.

The surgeon believes that the team was lucky: there was no threat to the babies’ lives during the operation. Everything happened under careful monitoring.
However, is it simply a matter of luck? And not in the high skill of all the doctors and nurses who participated in the operation? And can that truly desperate moment when the separation of a non-healing wound occur be classified as safe? At the same time, as Lev Borisovich briefly put it, the postoperative period passed without complications. Infusion therapy was carried out for two days, and on the third day the body temperature returned to normal. 22 hours after the operation, the children were given a glucose solution through the pacifier, and then regularly began to be fed with Similak milk formula; the sutures were removed on the 12th day. It would seem that there are grounds for satisfaction... Ada Vladimirtseva, personal. corr. “MG”, Chelyabinsk. (“Medical newspaper”, Moscow, August 12, 1990).

04/07/2001 Surgeons in Singapore performed an operation to separate the Siamese twins Ganga and Yamuna Shrestha(Ganga and Jamuna Shrestha) from Nepal.

The operation to separate them was complex and lasted more than 90 hours instead of the planned 36, so doctors had to work in shifts. During the operation, surgeons had to separate hundreds of intertwined blood vessels that connected the girls' brains.

It is expected that the sisters will develop more slowly because at first they could not move freely.

They managed to leave the hospital after almost six months. They did not go to the village where they were born, but remained in the capital of the country, Kathmandu, under the supervision of doctors.
Doctors in Singapore worked for free, the rest of the costs were covered by private donations. However, this money was reportedly not fully spent. They were put into a special account so that future medical expenses could be paid for.

13.12.2001

British surgeons have successfully separated conjoined twins who were fused at the base of the spine, reports the BBC. According to the doctors from Birmingham (Birmingham), who performed this operation, it was only the third such operation in the world. The separated babies are now doing well.
Conjoined twins Eman and Sanchia were born to the Mowatt family three months ago at Birmingham Children's Hospital. They were connected not only by a section of the spine, but also by part of the intestine. However, during a 15-hour operation, surgeons managed to separate the twins without any visible complications.

The majority of the surgical team was made up of local specialists, but they worked with the assistance of Lewis Spitz of Great Ormond Street Children's Hospital in London, who is a specialist in conjoined twins. They had to separate the spinal cord.
In addition, doctors were faced with the need to divide the intestine. They also had to deal with the problem of not having enough skin to cover the defect created after the separation. To do this, a few weeks before the operation, skin-stretching balloons were placed and inflated under the twins' skin.

Statistics show that up to 80% of conjoined twins in the UK survive elective separations. The mortality rate among twins who were not separated is significantly higher. This is due to the predominance of inoperable cases among them, associated with severe developmental disorders of internal organs, including those requiring urgent surgical intervention, which, as doctors report, is many times more difficult.

06.06.2002
At the University of California Los Angeles clinic, an operation was performed to separate the fused skulls of sisters Maria Teresa and Maria de Jesus Quich-Alvarez and lasted more than 20 hours. They say their theoretical chance of survival was one in a million. However, everything went well, and doctors express hope that both girls will be able to live full lives.
Although Maria Teresa had to undergo three more operations subsequently.
Perhaps the most severe manifestation of craniopagia is the situation when two separate brains of twins have common vessels. When surgeons divide the vessels of the skull, serious circulatory problems can occur in the brain, most dangerous in adult patients. In children, the brain tolerates such complications much more easily.

A complex operation to separate conjoined twins joined at the head requires lengthy preparation and many diagnostic procedures. First of all, doctors make sure that the brains of the two twins are not connected, and they are functionally independent: they breathe, sleep and move asynchronously.
It is also important for doctors to determine how connected the twins' circulatory systems are. To do this, one of them is injected into a vein with a special substance, the path of which through the vessels is traced using an X-ray machine. The screen shows at what speed the substance moves from one twin to the other, and which vessels are involved in this process.
By determining the speed of movement of the same substance through the vessels of each of the twins, it is possible to assess how efficiently their hearts work and whether they are able to provide an autonomous blood supply to their bodies after separation. The speed and efficiency of removal of the radiopaque substance from the body allows us to judge the functioning of the kidneys.

The proportion of craniopagus among all conjoined twins is no more than six percent. This pathology occurs when an embryo, giving rise to two identical embryos, does not completely diverge. This process occurs in the second week of pregnancy. The skulls of twins are most often fused in the parietal region; occipital and frontal fusions are also common.
The most successful operations are to separate twins who have a small number of common vessels and no defects in the meninges. In this case, the fusion of two different skulls occurs only in a small area.
Most often, complications occur in the case of so-called complete craniopagus. A tomogram of the skull of such twins shows a single cranium containing two brains. However, even with a large area of fusion, a positive outcome of the operation is possible, provided that the twins have few common vessels.

Siamese twins separated in St. Petersburg

Over the past 50 years, this is the fifth case of the birth of conjoined twins in the city and the Leningrad region. And the second successful operation...

The x-ray shows how the sisters are fused with their chests and partially their tummies.

Sisters Anya and Masha Yakushenkov were born on March 31, 2003 in maternity hospital number 16 in the city on the Neva. Two babies with a total weight of four and a half kilograms are fused with their chests and partially their tummies. Both the doctors and the expectant mother knew in advance that the twins would be Siamese. They also knew, albeit in general terms, exactly how the girls grew together. The 35-year-old mother was seen by the best doctors in St. Petersburg...

Immediately after birth, the Siamese sisters were taken to the Center for Resuscitation and Intensive Care of Newborns at Children's City Hospital No. 1. The babies were examined and it was concluded that an operation was needed to separate them. It was carried out by two teams at once - cardiologists and neonatologists. The doctors worked for about an hour.

The operation was very difficult, because... The sisters ended up with a common heart bag, and there were two hearts in it, which had to be separated. Fortunately, everything went well...

(Laleh and Ladan Bijani).

True, in one of the twins it turned out to be weaker; doctors discovered a heart defect in the girl. I had to do another operation. According to the doctors, the operation was successful.
Over the past fifty years, this is the fifth case of the birth of conjoined twins in St. Petersburg and the Leningrad region and the second successful operation. The first was carried out in 1997 in the same First City Hospital (“KP” talked about this in detail on December 9, 1997).

These operations are approximately the same in complexity, only five years ago the sisters were separated when they were almost a month old. But over time, the level of equipment has improved, and this time we were able to operate on the babies within a week after birth.

03/28/2003 Doctors from the Moscow Filatov Hospital performed a unique operation to separate two Siamese twins. Girls from Kyrgyzstan were saved by the best pediatric surgeons in Russia.
The operation in total lasted about 12 hours. One of the difficulties in preparatory stage, according to doctors, was to pick up correct dose anesthesia After all, girls are different. One of them, for example, was more excited, the other calmer. Well, one can only guess about what miracles happened during the operation. After all, the girls had one between them bladder, one kidney and three legs.

The most difficult part of the operation, which lasted 10 hours, was the division of the abdominal cavity, which Zita and Gita shared. For now, the sisters are not allowed to eat or drink. Doctors are waiting for the intestines to recover normal work. However, Gita and Zita, lying in intensive care, are already talking among themselves and with the staff. Parents are not yet allowed to see them, since the children are still in intensive care. But relatives regularly receive information from doctors about the girls’ well-being.
After the separation, each sister had only one leg left. But, according to doctors, it is too early to think about prosthetics.
In recent years, the sisters, joined by their bodies, lived not only in Kyrgyzstan. Their relatives took them to different countries of Western Europe in the hope of finding doctors who would agree to perform a complex operation. However, in the end, domestic specialists decided to separate the 11-year-old girls.

In Singapore, on July 6, 2003, an operation began to separate 29-year-old Siamese twins Lale and Ladan Bijani.(Laleh and Ladan Bijani).
The Bijani sisters were born in 1974 in Tehran. Their bodies are separate, and their heads are connected at the scalp. As the sisters admitted, their life's dream was to see each other's faces without the help of a mirror.

Periodically appearing reports of successful and not so successful operations to separate conjoined twins suggest that more of them are being born than before. Is this so and why are such children born at all? Is it possible to predict their appearance on early stages pregnancy?

The Thai Siamese twins Pantawan and Panwad Thienjai were lucky to be born at the beginning of the 21st century with the modern level of development of medicine. Although, of course, it’s probably wrong to talk about luck when the girls’ hearts and livers were fused together. However, 60 doctors managed to separate the sisters in a Bangkok medical center in 12 hours, and now this operation is considered the first successful case of separation of the heart and liver in world practice.

Previously, an attempt to separate the common heart and liver of two American sisters Emmy and Angela Lakeburg was made in the United States in 1993. Moreover, even before the operation it was known that one of the sisters would have to die. But after the end of the medical intervention, the surviving sister, 10 months later, becomes infected with pneumonia and dies right within the walls of the hospital.

But, despite the successes of Asian doctors, Americans still remain the leader in successful operations of conjoined twins. This is explained by the fact that such interventions began there back in the 60s of the last century, accumulated great experience, and over the past 10 years, 250 operations have been performed in US clinics, which allowed either both or one of the twins to survive. In 2005, Egyptian boys Mohammed and Akhmet, who were born with a fused brain, were successfully operated there. The operation lasted more than a day. General statistics show that it is possible to save the lives of both or at least one Siamese twin during separation in 75% of cases.

Why "Siamese"?

Brothers and sisters, fused with different body parts, have probably always been born. The first mention of such an anomaly that occurred on the territory of Armenia dates back to 945. Probably the first documentary evidence of Siamese twins is kept in the Philadelphia Museum: a description of the so-called Bidden maidens. Sisters Mary and Eliza Chulkhurst were born in Bidden, Kent, England in 1100. They were joined at the hips and died at the age of 34.

And the first operation to separate conjoined twins was performed in 1689 by the German surgeon Koenig. But the twins Eng and Chang, born on May 11, 1811 in Siam (now Thailand), became truly famous in the world and gave their name to this natural phenomenon.

Miraculously, thanks to the fortitude of their mother, having avoided death in infancy when the King of Siam ordered the death of children bearing the “seal of the devil,” the brothers brought fame not only to themselves, but also to their country. Joined at the waist, Eng and Chang traveled the world and showed themselves to the public, which also brought them a lot of money.

Newspapers wrote about them, they were received by European royal courts, and in 1839, having completed their tour, they finally settled in the United States and took up farming. Things went well and soon both brothers married the Jans sisters, who, we note, were not Siamese. In total, the two couples produced twenty-one children. All the children turned out to be normal, except for Chang's two sons, who were born deaf-mute.

There was a moment in their lives when the brothers visited the surgeon with a request to separate them. But the doctor refused, suggesting it would be better to cut off their heads right away. True, he advised them to immediately go on the operating table if one of the twins suddenly died, in order to save the life of the other. But in 1874, when Chang died suddenly in his sleep, there was no doctor nearby, and Eng outlived his brother by only three hours.

Where does trouble come from?

Today, scientists cannot answer the question of why conjoined twins are born in one case out of 10 million newborns.

Although they have a good idea of how this happens. Typically, the egg, if the lives of two identical twins (those who then look the same) begin to develop in it, splits into two within two weeks after conception.

But if splitting does not occur on the 13th day, then it remains fused. Depending on whether earlier or later the egg decides not to split, the most different kinds fruit compounds.

Sometimes it happens that one of the twins develops only partially, and people are born with three or four arms or legs growing from different parts of the body. Perhaps the most unique variety of Siamese twins was the French nobleman Lazare John Baptista Colloredo, who lived in 1617. A brother grew from his belly, facing Lazar.

The reasons for such incorrect divisions of the egg are not completely clear, but doctors name among the first: genetic failure, environmental influences, various toxic factors, side effects medications and even psychological aspects.

Can expectant mother find out in advance whether Siamese twins are developing in her womb? It would seem that at modern methods research is not difficult. But in practice everything turns out to be more complicated. Recently in Israel, where the level of development of medicine is beyond doubt, a scandal erupted. At Sheba Hospital in Tel Hashomer, an Orthodox Jewish couple gave birth to girls joined at the belly.

But the essence of the scandal was not the birth of conjoined twins, but the fact that the woman went through everything necessary tests, including ultrasound examinations, both two required by the rules, and several additional ones, in the period from 18 to 26 weeks of pregnancy. All the doctors unanimously said: pregnancy is underway ok, the twins are absolutely healthy.

On the other hand, if doctors manage to determine in time (usually with the help of ultrasound examination) that a woman is carrying conjoined twins, modern medical technologies sometimes make it possible to separate them in the womb. True, this usually leads to the death of one of the brothers or sisters.

“It is not always possible to determine before birth whether a mother is carrying Siamese twins or just twins,” says Professor Elena Andreeva, head of the gynecology department of the Endocrinology Center of the Russian Academy of Medical Sciences. – The accuracy of the diagnosis depends on exactly how the twins are fused (if in the abdominal area, then it is more difficult to see the pathology), on the quality of the equipment used for the study and, of course, on the qualifications of the doctor. In addition, when and at what stage of pregnancy the study was conducted also plays a role. The optimal period for identifying such a deviation is from the 20th to the 30th week of pregnancy.”

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) twins - from one fertilized egg, on early stage 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 occurs, there are several types of development of monozygotic twins:

1. In very rare cases (1% of all monozygotic twins), splitting occurs quite late, when the amniotic sac 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).

Conjoined (or conjoined) twins are monozygotic, meaning they have the same set of genes and are always the same sex. Conjoined twins occur if this cleavage is delayed until the 13th day after conception. Thus, they are monozygotic twins who were not separated in the womb and remain conjoined after birth.

First, a few basic facts. Among conjoined twins, there are three times more women than men, and they are most often born in Africa and India. This is a very rare occurrence. There are about a dozen couples currently living in the United States. Most conjoined twins die in the womb, and the pregnancy ends in miscarriage. Three quarters of conjoined twins are either stillborn or die shortly after birth. They are born in approximately one case out of 200 thousand. The birth of conjoined twins usually comes as a surprise to parents because there may be no signs throughout the pregnancy that the woman is carrying conjoined twins.

Several fusion options are possible. Some twins are very closely fused and may share internal organs, such as the liver. Others are connected by a small area of skin.
Scientists classify Siamese twins according to the parts of the body they are fused with.

Why does the connection occur? According to modern research, many factors can lead to delayed zygote splitting. These include genetic and environmental influences, as well as exposure to toxic substances. But cases of the birth of conjoined twins, recorded thousands of years ago, received much more colorful explanations in those days. For example, in 1495, two girls were born in Europe with their foreheads joined; this incident was explained by the fact that their mother, being pregnant, accidentally hit her head against the head of another woman. Her fright affected the embryos, which led to the appearance of conjoined twins. Ambrose Paré, a 16th-century surgeon, said that conjoined twins “disturb the natural order of nature.” He believed that supernatural forces were to blame for the birth of conjoined twins - the wrath of God, the machinations of the devil - as well as the fact that the woman had a too small uterus, wore tight clothes or sat in the wrong position during pregnancy. 18th-century researchers believed that twins, initially separated, grew together when they met each other in the womb, or developed from a single egg fertilized by two sperm. These theories are on this moment Almost no one adheres to it.

Scientists at the Frankfurt Institute of Human Anatomy have come to a truly paradoxical conclusion. They were able to prove that the phenomenon of conjoined twins being born is a consequence of a psychological illness known as split personality.
The study, conducted by German scientists, goes against an earlier theory, according to which the appearance of conjoined twins is the result of a genetic error, a kind of mutation.
Tests conducted on a group of monkeys made it possible to finally dot all the i’s. As it turned out, 80% of animals exposed to continuous psychotropic effects during the pregnancy cycle gave birth to Siamese cubs.

Siamese twins have always captured the imagination of others. They led to the emergence of Roman myths about the two-faced god Janus and Greek legends about the centaur - half-man, half-horse. The first mention of Siamese twins dates back to Armenia in 945, although the current name for this phenomenon appeared only in 1911 thanks to the famous Banker brothers - Chang and Eng (these names translated from Thai mean “right” and “left”). They were born on May 11, 1811 in Siam (now Thailand). Their bodies were connected in the sternum area by a short tubular cartilaginous ligament, but the commissure turned out to be flexible, so they gradually learned to sit, and by the age of 12, to walk. When the twins became adults, this ligament reached 10 cm in length and approximately 20 cm in width.

When the brothers were 17 years old, an American dealer took them to the United States to show them in show business. There they were offered surgical separation, but then doctors considered such an operation mortally dangerous. Although the twins were quite limited in their movements, they could walk 13–16 km, they could run fast, and swam well for short distances. When moving, they seemed to obey common impulses, react sharply to each other’s condition and had similar tastes in everything. Chang, who was an inch shorter than his brother, wore special shoes to compensate for the difference. The Siamese twins traveled all over the world with their tours. In 1843 they married two sisters. Chang had 10 children, and Eng had 12 children. In their entire lives, as the brothers claimed, they quarreled only once, in childhood, while swimming, when the water seemed too cold to one, and warm to the other. They died in 1874, at the age of 63. The first to die, from pneumonia, was Chang-Eng, who was sleeping at that time. Soon Eng discovered that his brother was dead, and two hours later he also died from intoxication with cadaveric poison.

The Bunker brothers are not the only conjoined twins who managed to live undivided long life. The “Scottish Brothers” (15th – 16th centuries) and the “Bohemian Sisters” (19th – 20th centuries) became especially famous.

Rita and Cristina were born in the twenties of the 19th century in Sardinia. They had separate upper parts body, but only with one pair of legs.
Their parents brought them to France in 1829 in the hope of making a fortune from their abnormal offspring. But they failed to obtain permission to speak publicly, and the twins died of hunger and cold. The skeleton of Rita Christina is kept in the Natural History Museum in Paris.

In 1878, sisters Rosa and Josepha Blazek, joined at the buttocks, were born.

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, apparently in search of a more convenient wife.

The most famous Siamese sisters were Daisy and Violet Hilton.

Joined thighs beautiful girls played one of the main roles in the film "Cripples" by Tod Browning. In 1937, they were earning $5,000 weekly 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 loved each other incredibly. They could be disconnected from using easy surgery, but the sisters did not 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, dragging her sister into the coffin with her.

Masha and Dasha Krivoshlyapov were born on January 4, 1950 in Russia to Ekaterina and Mikhail Krivoshlyapov. Catherine was first told that her daughters had died, and after a while her 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 from medical authorities, he signed the death certificate for his daughters and never wanted to know anything about them again. Their spines are fused, and below the waist the body is one for both. Moreover, each brain controlled only one leg.

Medicine could not miss the opportunity to study such rare case dicephales tetrabrachius dipus, and girls during for long years were guinea pigs. Physiologist Pyotr Anokhin studied them for 7 years at the Institute of Pediatrics of the USSR Academy of Sciences.
They were then placed in the Central Research Institute of Traumatology and Orthopedics, where their third leg was amputated so that, as the sisters admitted in an interview given in 1989, “it would not attract so much attention.” There the girls were taught to move with the help of crutches and given a primary education.
In 1964, Masha and Dasha were placed in a boarding school for children with motor problems, located in Novocherkassk. The guide medical institution treated the sisters as mentally retarded, and despised the rest of the Krivoshlyapov children. The medical staff did not pay any attention to the chronic nephritis that both girls suffered from. And although at times the pain was so severe that they screamed at the top of their voices, the doctors remained deaf.
In 1970, the sisters fled to Moscow. After living for several years in the dental complex of the capital, they turned to the management of the N6 nursing home to be allowed to settle there. There they spent the rest of their lives. Shortly before their death, at the invitation of a French company, they visited Paris.
They were brought to the hospital on the morning of April 13, 2003. Masha was diagnosed with an acute heart attack. For half an hour, intensive care doctors tried to “restart” the stopped heart. Defibrillation and adrenaline did not help. 17 hours after Masha’s death, Dasha died of intoxication. Dasha was not told that her sister had died. They said she was just "sleeping soundly." Dasha was getting worse every hour. She complained about headache, weakness. Dasha died at half past five in the morning, in her sleep.

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 right hand, and her sister - with the 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 cross 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 by the Los Angeles Music Awards Program, which supports young artists. Program director 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 Lori works 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 her privacy, Reba becomes quiet and her thoughts drift away, so although she is physically there, she is not really there. “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.”