O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 2 | 17 O&G Forum 2021; 31: 17 - 18 CASE REPORT Oropharyngeal fetus in fetu at Dr George Mukhari Academic Hospital. Revisited. KE Kabala, OP Chukwu, O Gavi, L Matsela, ST Monokoane Department of Obstetrics and Gynaecology, Sefako Makgatho Health Sciences University Introduction Fetus in fetu is a rare congenital abnormality which occurs in 1 /500.000 birth. It was described for the rst time in the 18thCentury byMeckel, as the presence of a parasitic twin in the body of its sibling twin. erearelessthan200caseswhichhavebeenreportedsofar,withthemajority being located in the retroperitoneal region and only a few oropharyngeal fetus in fetu cases have been reported, favouring a preponderance of 2:1 in males. 1 In 97% of cases, the prognosis is good following complete surgical resection of parasitic twin. 4 e condition carries a high risk of airway obstruction, hence an antenatal diagnosis by ultrasonography is paramount. Multidisciplinary approach plans a major role in the planning and execution of Ex-utero intrapartum procedure. e exit procedure is meant for maintenance of fetoplacental circulation during the caesarean section until the neonate’s is secured. Adequate counselling to the mother about the bene ts and risks must be clearly outlined. Case Report A 36 years old patient P2G3, a referral from Rustenburg Provincial Hospital with the following problem list: pre-eclampsia, polyhydramnios, gastroschisis, pre-term labour and previous caesarean section at 28 weeks gestation. e patient booked early at the local clinic at Rustenburg for antenatal visit. Her age classi ed her as an advanced maternal age, and the timeous referral was mandatory. e patient could have bene ted from an early fetal anomaly scan at a tertiary hospital. Multidisciplinary approach to this case could have been planned. On arrival at Dr George Mukhari Academic Hospital, the patient was reassessed andmisdiagnosis of gastroschisis was repeated, and the rest of the problem list was con rmed by the attending practitioner. Abstract Background: Fetus in fetu is a rare malformation in which a parasitic twin is within a more mature twin. Most of the fetus in fetu are located in the retroperitoneum and are acardiac and anencephalic. Case report: Oropharyngeal fetus in fetu, referral from Rustenburg hospital with suspected gastroschisis, pre- eclampsia, preterm labour at 28 weeks gestation. Conclusion: Prenatal ultrasound remains the cornerstone of diagnosis of fetus in fetu in providing essential information for management and parental guidance. Keywords: Fetus in fetu, Oropharyngeal, prenatal ultrasound, Exit procedure. Consent was obtained from the mother for the publication of this article. Correspondence Prof Lineo Matsela email: lineomatsela@yahoo.com e patient was presented to the consultant and the decision to perform an emergency caesarean section was made, due to severe pre-eclampsia. Findings at operation were as follows: A female neonate with multiple large cysts originating from the mouth with nasal attachment were found thus, resulting with respiratory obstruction. e parasitic twin was anencephalic with one eye and loops of bowel identi ed. e neonate died soon a er caesarean delivery, due to failed intubation as a result of the cystic masses that were obstructing the airway. e diagnosis in this case wasmade retrospectively and hence led to poor management of the neonate. Discussion Fetus in fetu is a rare congenital malformation, which occurs in diamniotic monochorionic pregnancy, resulting fromunequal division of the totipotent inner cell mass of the developing blastocyst, leading to the inclusion of a smaller cell mass within a maturing sister embryo. 2 Fetus in fetu is a term coined by Johann Friedrich Meckel in the 18th century, 3,4 initially reported in 1935, 5 and de ned byWillis in 1953, as amass characterized by vertebral axis o en associated with other organs or limbs around the axis. 3 It is a rare entity, with an incidence of 1 in 500.000 deliveries, 5 whereby a Figure 1. Multiple cystic masses and polyhydramnios on ultrasound.