How AIIMS doctors removed 17-year-old UP boy’s ‘parasitic twin’ in rare surgery

A ‘new world’ has opened for a 17-year-old boy in Uttar Pradesh’s Unnao, who had to live with his “parasitic twin” until now. The teen was ridiculed and stared at because of his unusual appearance.

Now, he will no longer be a subject of mockery after undergoing a life-changing surgery. Doctors at the All-India Institute of Medical Sciences (AIIMS), Delhi, have removed the “parasitic” twin that was attached to his torso.

But what is a “parasitic” twin and what’s the case? Let’s take a look.

What’s a ‘parasitic’ twin?

A parasitic twin is a rare condition that happens when a conjoined twin stops developing but stays attached to its surviving twin.

According to the Cleveland Clinic, the healthy, developed twin is born with additional limbs, organs or tissue from its parasitic twin.

The surviving twin could be susceptible to medical complications and will need medical treatment after birth.

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Researchers are not totally certain why such cases occur. However, they refer to two main theories – the fission theory and the fusion theory.

According to the fission theory, if a fertilised egg does not separate completely, it leads to conjoined twins. When one of the foetuses in a conjoined twin stops developing, a parasitic twin is formed.

“The fusion theory suggests two separate fertilised eggs grow or fuse together during development. A parasitic twin occurs when one of these two fertilised eggs stops developing but remains attached to its twin,” as per the Cleveland Clinic.

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The condition is extremely rare, with less than one case occurring per 10 lakh births globally.

AIIMS doctors remove UP boy’s ‘parasitic’ twin

Doctors in AIIMS Delhi carried out a “rarest of rare” surgery on a teen boy from UP, removing an extra set of limbs and a pelvis belonging to his underdeveloped twin.

It took two-and-a-half hours to complete the surgery, which was done in two stages. The first part included removing the parasitic limb. The other stage concerned the large cystic mass in the boy’s abdomen, extracting it from the abdominal wall, bowel, and liver.

In this case, the teenager had lower limbs, buttocks and external genitalia of his twin – weighing roughly 15 kg – attached to his abdomen, as per BBC.

Dr Asuri Krishna, additional professor of surgery who led the team of specialists, told Indian Express that the biggest challenge they faced was to separate tissues shared between the surviving and parasitic twin. They had to separate a mesh of blood vessels and nerves, along with separation of tissue near the chest wall, bowels and liver.

Notably, the parasitic limbs could feel pain, touch and change in temperature.

“Apart from a dull ache in his abdomen and flanks, he [the teen] had normal bowel and bladder function, ate regularly, and had no other major health issues,” Dr Krishna said.

A team of doctors, including radiologists, anaesthetists and plastic surgeons, carried out the surgery .

Speaking to BBC, Dr Krishna said the first task was to find out how interconnected the parasitic and host twins were.

The scans revealed that the parasitic twin was linked to the boy’s breastbone and was taking blood supplied from a vessel in his chest.

“We performed a CT angiography to assess the blood supply to the parasitic limb and found that it was supplied by a branch of the internal mammary artery, which usually supplies the chest wall. This made the situation more challenging. A large cystic mass was also found in his abdomen during the CT scan” radiologist Dr Ankita Agarwal told Indian Express.

The doctors tied the blood vessels supplying the parasitic limb and separated the bony attachment. “The underdeveloped testes of the parasitic twin were found in the soft tissue at the attachment site, and the limb was completely removed,” Dr Krishna said to the newspaper.

As per BBC, during surgery, the boy’s blood pressure dropped significantly as 30-40 per cent of his blood flowed to the parasitic twin. However, the doctors were prepared for this scenario and stabilised him quickly.

In the second part of the surgery, the doctors removed the cystic mass in the teen’s abdomen from surrounding organs.

According to Dr Krishna, the boy’s age made the surgery difficult. “Only 40-50 cases of parasitic twins have been documented in world medical literature and, in those cases, the surgery had been attempted on children,” he told BBC.

Dr Krishna said that due to a lack of adequate medical literature, the team of doctors had to rely on their “intuition, skill and knowledge” for the surgery.

A ‘new world’ for teen

The boy, who suffered physically and emotionally for 17 years, is finally free. “People often misunderstood him, and he felt isolated, spending much of his childhood alone. He consulted local doctors, but they told him that removing the limb could be fatal because it shared a common heart with him. As a result, he continued to live with the limb. He also struggled with schooling and had to drop out in class VIII, unable to return to school since then,” he told Indian Express.

The teen is now well and was discharged four days after being hospitalised.

As per Times of India (TOI), doctors said that the boy did not have any additional health complications.

The teen, who had to leave school in class VIII, plans to resume his studies. “I couldn’t travel anywhere or do any physical activity. Now a new world has opened before me. I hope to study and get a job,” he told Indian Express.

With inputs from agencies