Accessory limb attached to the back.

The authors report on a newborn with an accessory malformed leg attached to the back. The limb was associated with a teratomatous mass adjacent to its attachment site. The embryology and nomenclature of this malformation is discussed briefly.

Epigastric heteropagus.

Incomplete parasitic twinning with the parasite attached at the host's epigastrium is extremely rare. We report a case of epigastric parasitic twinning where the parasite with a well-developed pelvis and lower limbs had accessory pelvic organs and was attached to the host above an omphalocele. The parasite was excised and the omphalocele managed conservatively by mercurochrome application. A review of the four previously reported cases is presented along with a discussion of the possible etiopathogenesis and nomenclature of this condition.

An unusual form of caudal duplication (dipygus).

An unusual case of caudal duplication is presented in which the infant had an extra lower limb with 14 digits attached to an accessory parasitic pelvis situated in the midline subpubic area. Duplication of the external genitalia was also present. Successful excision of the accessory limb and reconstruction of the genitalia was performed in the neonatal period.

The embryology and management of congenital pouch colon associated with anorectal agenesis.

Forty-one infants with a pouch colon malformation accompanied by a high anorectal anomaly were treated between January 1986 and December 1990. The 41 cases constituted 9% of all anorectal malformations and 15.2% of high defects managed during this period. There were 32 boys and nine girls; three of the girls had an associated cloaca. Many of the babies presented in poor condition, with gross abdominal distension caused by the distended colonic pouch. The typical radiological feature was an enormously distended colonic shadow occupying more than 50% of the width of the abdomen. At the time of surgery, the patients were classified into 4 subgroups based on the length of the normal colon. All but three infants had a high wide fistula, with the genitourinary tract consisting of a colovesical fistula in males and a colovaginal or colocloacal fistula in females. Frequent associated malformations included duplication of the appendix and vesicoureteric reflux. The operations performed initially were a window colostomy of the pouch with or without division-ligation of the fistula, end-colostomy after fistula ligation, or subtotal pouch excision with tubularization of the remaining colon and end-colostomy. Thirteen of the 41 patients have undergone a definitive pull-through operation using the posterior sagittal approach, including two children in whom one-stage reconstruction of a cloaca was performed. Standardized management of this complex anomaly is proposed for the initial operation and for definitive reconstruction.

Congenital fusion of the gums.

Congenital fusion of the gums is a rare abnormality. This is a report of a successfully treated newborn infant who had unilateral fusion of the gums. A brief review of the previously reported cases is also presented.