The country’s first conjoined twins, who were admitted at the country’s main referral hospital, share a liver, according to an RVTH medical report transmitted by Dr Tamsir Mbowe, the director of Health and Medical Services.

A CT scan conducted at the RVTH indicated that the twins share a liver at the lower base. However, the medical report added that the Jallow twins have separate hearts, lungs and sternum, intestines, kidneys and genital organs. But the gall bladders could not visualised. There is a congenital cardiac defect in the right twin.

The report strongly recommended that the omphaloplagus conjoined twins require further investigation and assessment by a multidisciplinary paediatric surgical team with experience in this field. “This is not available in The Gambia,” the report stated.

Medical details

The twins were born at term by elective caesarean section at the Gambia Family Planning Clinic. An ultrasound scan done two days previously showed conjoined twins. The apgar scores were 10 at 1+5 minutes. Mother received antenatal care but no regular scans. There was no maternal illness or medications taken during pregnancy.  Birth weight was 6.4 kg.

“Mother is 28 yrs old and Fula tribe. The parents are non consaguineously married.  The father works as a petty trader. They have three children aged 7yrs, 4yrs, 1/2 yrs - who are all well. Since admission to the neonatal unit they were stabilized on oxygen and IV fluids,” the report stated.

On day three, the report continued, they developed fever and are currently being treated for neonatal sepsis. “The right sided twin has had persistent low oxygen saturations and respiratory distress since birth and we are suspecting a congenital cardiac malformation. At present, the right twin is in oxygen and is tolerating feeds of 30 ml 2 hourly and is afebrile. The left twin is in air and also tolerating feeds with lactogen and is afebrile at present,” the report added.

Examination

“Joined thorax to umbilicus, female twins facing each other.  No dysmorphism. Weight today is 5.5 kg. Right twin (1) - OFC 34.1 cm, pulse 160 RR 60.  Sp02 93% in oxygen, 85% in air.  Active precordium with soft grade 2 systolic murmur. Lung fields clear, No sc / ic recession. Abdomen soft and no masses/ organomegaly. Normal tone and movement of all limbs. Left twin (2) - OFC 34.0 cm, pulse 15 RR 58 SPO2 98% in air.  Normal heart sounds and lung fields.  Abdomen soft and no masses / organomegaly. Normal tone and movement of all limbs.”

Medications

Ceftriaxone iv 50 mg/kg BD - 2 days, Flucloxacillin iv 25 mg/kg, TDS - 2 days, Gentamicin iv 2.5 mg/kg bd - 4 days (Echocardiography: Not available at present).