Siamese twins

Siamese twins

Siamese twins, more commonly referred to in modern medical literature as conjoined twins, are a rare phenomenon where twins are physically connected to each other at birth. This condition occurs when the developing embryo only partially separates to form two individuals. Although the term "Siamese twins" originated from the famous case of Chang and Eng Bunker, twins born in Siam (now Thailand) in 1811, it is considered outdated and potentially offensive. The preferred term is "conjoined twins." Conjoined twinning is believed to result from a delayed splitting of the embryonic disk more than 12 days after fertilization. The exact cause of this delayed splitting is unknown, but it is not related to genetic or environmental factors. Conjoined twins can be connected at various parts of their bodies, and the point of connection often determines the complexity of the separation surgeries they may undergo after birth. There are several types of conjoined twins, classified by the point of connection:

• Thoracopagus twins are joined at the chest and may share a heart, making separation surgery particularly complex.
• Omphalopagus twins are connected from the lower chest to the pelvis but do not typically share a heart.
• Pygopagus twins are joined back-to-back at the buttocks.
• Craniopagus twins are joined at the head, sharing portions of the skull and sometimes brain tissue.
• Ischiopagus twins are joined at the pelvis.

The medical management of conjoined twins is highly complex and individualized, often involving multidisciplinary teams. The primary considerations are the extent of shared organs and the potential for each twin to survive and thrive after separation surgery. In some cases, separation is not possible or advisable due to the risk to one or both twins. The ethical considerations surrounding the treatment of conjoined twins are significant. Decisions about surgery, including whether to attempt separation and the timing of such a procedure, must balance the potential benefits to each twin with the risks involved. These decisions are made in close consultation with the twins' family and a team of medical, ethical, and psychological experts. Conjoined twins are a subject of public fascination, which can lead to challenges in ensuring their privacy and dignity. Advocacy for conjoined twins and their families focuses on promoting understanding, respect, and appropriate medical and social support.