From observation to aetiology: a case report of a twin fetus-in-fetu and a revisit of the known rarity.

A baby girl presented with an antenatal diagnosis of a retroperitoneal tumour. Postnatal imaging suggested that this mass contained two fetiform structures with spine and long bone formation. This teratomatous mass was completely excised at 3 weeks of age. Histology was consistent with twin fetuses-in-fetu, revealing two fetiform masses each with an umbilical cord connecting to a common placenta-like mass. Despite a difference in the weight of the twin fetuses-in-fetu, the level of organogenesis was identical and corresponded to fetuses of 10 weeks of gestation. Each mass had four limbs, intact skin, rib cage, intestines, anus, ambiguous genitalia, primitive brain tissue and a spine with ganglion cells in the cord. Although considered a mature teratoma in the current World Health Organization classification, the theory of formation from multiple pregnancies has been commonly implied in more recent literature. The true aetiology of this rare condition remains unclear.

A surgeon-friendly technique to perform single-incision laparoscopic appendectomy intracorporeally in children with conventional laparoscopic instruments.

BACKGROUND: Single-incision laparoscopic appendectomy (SILA) has been successfully performed in children. The intracorporeal approach, using reticulating instruments and 5- to 10-mm ports, has been described in recent reports. In this article, we describe our technique of performing SILA in children, using conventional 3- and 5-mm ports and instruments only. METHODS: We conducted a retrospective review of all consecutive children who underwent SILA over a 3-month period by a standardized technique of using one 3-mm and two 5-mm ports. The procedure was completed intracorporeally by conventional instruments, and the specimen was retrieved without wound contamination by a simple method. RESULTS: Eleven consecutive children (8-14 years), with a mean body weight of 38.5 kg, underwent successful SILA by our technique during the review period. Mean operating time was 83 minutes. There was no conversion to conventional laparoscopic or open appendectomy. Mean postoperative analgesic requirement was 2.4 doses of oral acetaminophen, and no narcotic analgesic was required. All the patients recovered smoothly without complications. CONCLUSIONS: SILA can be safely performed in children when using standard laparoscopic instruments without additional costs in equipment. Using 3- and 5-mm ports seems more appealing to children, with their smaller umbilicus, than adults.