Specifičnost sestrinske skrbi u zbrinjavanju sijamskih blizanaca

Abstract

Conjoined ("Siamese”) twins are one of the rarest congenital anomalies with an incidence of about 1.47 per 100,000 births in the Western world. This rare natural phenomenon is present in only 1% of monozygotic twins, i.e., 0.05% of live births. Most of them are stillborn (40-60%) or die early in life. The majority of live births are female (75%), which is why the female karyotype is considered to be beneficial in terms of survival. Conjoined twins are created when the zygote begins to separate after 13 days post-fertilization, at a time when the so-called embryonic disc has already been formed. Instead of producing two separate embryos, this late separation causes incomplete separation of the embryos. The name comes from conjoined twin brothers Chang and Eng Bunker, who were born in Siam. Surgical separation of conjoined twins is usually a very demanding and complex procedure, and often not even possible. Survival after separation depends on the type of connection. This paper presents the case of conjoined twins who were born at 33 weeks. At 11 weeks of pregnancy, the doctors suspected that the twins were joined ventrally (omphalopagus – twins joined at the abdomen). The diagnosis was confirmed by fetal MRI at 21 weeks. Separation was indicated at the age of 45 days and a combined body weight of 4,700 g. Long postoperative recovery and treatment lasted three months and was complicated by infections and problems with the healing of the surgical wound of one of the twins. Treatment and recovery required a multidisciplinary approach and a well-educated team of doctors and nurses.