ABSTRACT
The earliest example of conjoined twins is a 17 cm marble statuette portraying parapagus twins, “the double goddess,” dating from the sixth millennium bce. The statue of the sisters of Catathoyuk is in the collection of the Anatolian Civilization Museum in Ankara, Turkey. Another early example is a stone carving of pygopagus twins dated to 80 bc in the St Marco Museum, Florence, Italy. In pygopagus, ischiopagus, and parapagus, the intestines are separate to the level of the Meckel's diverticulum. The common terminal ileum and colon have a dual blood supply. Despite every attempt to define as accurately as possible all anatomical connections prior to surgery, “unexpected events” are frequently encountered during the operation. Examples in our experience include abnormal vascular communications, and previously unidentified intestinal and GU anomalies. Meticulous attention should be directed at monitoring fluid and electrolyte balance, and in particular avoiding over-hydration which may precipitate cardiovascular instability.
