For 17 long years, Mukesh (name changed to protect his identity), a native of Balia in Uttar Pradesh, carried the weight of an extra two limbs protruding from his abdomen. This unusual condition that set him apart from his peers brought him immense physical pain and deep emotional struggles, leading to significant social stigma.
However, hope emerged when doctors at AIIMS Delhi successfully removed the incomplete parasitic twin, giving Mukesh a second chance at life filled with dignity. This groundbreaking procedure marked a first for the prestigious hospital and is now one of only 40 such cases reported globally, particularly noteworthy as it was detected at a young age.
Dr. Asuri Krishna, Additional Professor in the Department of Surgery, recounted how Mukesh came to the surgical outpatient department in late January, presenting with two extra lower limbs.
“We had heard about twin pregnancies. Sometimes, twin fetuses fail to separate from each other in the womb and are born as conjoined twins. Very rarely does one of the twins not form completely and is born attached to the other twin as a parasitic limb. While conjoined twins are rare, this case was even rarer than that… It was a one in a million case,” Dr Krishna explained.
Most cases of parasitic twins are diagnosed early, but Mukesh’s condition went unrecognized until he was 17. The complexity of his anatomy required a collaborative effort from various specialists, including general surgeons, radiologists, plastic surgeons, and anesthesiologists. On February 8, the surgery took place, lasting two hours, during which both the parasitic limb and a cyst were removed.
Mukesh spent 24 hours in the ICU for monitoring and was discharged on the fourth day post-surgery. “He is now free from the stigma that once overshadowed his life and is eager to start school,” said Dr. Krishna.
Conjoined twins are rare, occurring in about 1 in 50,000 to 100,000 births, and parasitic twins are even less common. These cases vary widely, with only around 40 documented in medical literature. Mukesh had lived with the extra limb since birth The parasitic appendage, including underdeveloped male genitalia, grew proportionally with him. The boy experienced sensations, including touch, pain and temperature in the parasitic limb. Despite occasional abdominal discomfort, he maintained normal bodily functions without major health complications.
Local doctors had warned him against removal, claiming it could be fatal due to shared heart connections. However, a CT angiography revealed that the limb was supplied by a branch of the internal mammary artery, complicating the situation further. After thorough evaluation, the surgical team prepared for the challenging operation.
The surgery involved two main parts. First, the surgeons made a circular incision around the limb’s base, carefully tying off the blood vessels and separating the bony attachment. The underdeveloped testes of the parasitic twin were also found and removed. The second part focused on the cystic mass in Mukesh’s abdomen, which was carefully extracted after making a midline incision. It was discovered that his bladder extended unusually high, which was addressed during the procedure.
There was a risk of cardiac arrest, said anesthesiologist specialist Dr. Rakesh, but we managed the situation and after 10 to 15 minutes of improved blood pressure, we proceeded with the surgery to remove the parasitic limb.
Dr. Rakesh further said that there was a concern about excessive bleeding and a drop in blood pressure if an artery were to rupture, which is why preparations had been made ten days prior to the surgery.
Much to the everybody’s relief, Mukesh’s recovery was swift; he began eating on the first day after surgery, and his vital signs remained stable throughout. This remarkable outcome was achieved through the collective effort of a dedicated team of many specialists, including Dr. Asuri Krishna (chief operating surgeon), Dr. VK Bansal, Dr. Sushant Soren, Dr. Brijesh Kumar Singh, Dr. Abhinav Kumar, Dr. Jaymeen Makwana from the Department of Surgical Disciplines, Dr. Manish Singhal and Dr. Sashank from plastic surgery, Dr Ganga Prasad and Dr. Rakesh from anesthesia, and Dr. Atin and Dr. Ankita from the radiology department.
Now, with the burdens of his past lifted, Mukesh looks forward to a future filled with possibilities.