Introduction and importance: Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making.
Case presentation: Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure.
Clinical discussion: Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year.
Conclusion: The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.
Keywords: ARDS, acute respiratory distress syndrome; CDC, Centers for Disease Control and Prevention; COVID-19; COVID-19, coronavirus disease-19; CPAP, continuous positive airway pressure; CT-scan, computed tomography-scan; CUSA, cavitron ultrasonic surgical aspirator; Case report; Children; Conjoined twins separation; ECMO, extracorporeal membrane oxygenation; HCP, healthcare providers; HFN, high flow nasal; HFOV, high-frequency oscillation ventilation; ICU, intensive care unit; IVC, inferior vena cava; MRI, magnetic resonance imaging; MRSA, methicillin-resistant Staphylococcus aureus; NPWT, negative pressure wound therapy; ORC, oxidized regenerated cellulose; Omphalopagus conjoined twins; PCR, polymerase chain reaction; PDA, patent ductus arteriosus; PDS, polydioxanone suture; PICU, pediatric intensive care unit; POD, post-operative day; PPE, personal protective equipment; SCARE, surgical case report; WHO, World Health Organization; cm, centimeter; lpm, litres per minute.
© 2021 The Authors.