A Postnatal Incidental Diagnosis of Parapagus Disprospus Dibranchius Dipus with Discordant Craniorachischisis Totalis in a Resource-Limited Setting: a CASE REPORT

Abstract Background Conjoined twins are rare congenital anomalies with an incidence of 1 in 50,000 to 200,000 births. Parapagus diprospus dibrachius dipus twins represent one of the most severe forms of lateral fusion, and coexistence with craniorachischisis totalis is exceptionally rare and scarcely documented in literature. Accurate prenatal diagnosis is essential for counseling and prenatal management, but remains challenging in resource-limited settings where advanced imaging is unavailable. Case Presentation : We report a 22-year-old gravida 3 para 2 woman from Ethiopia who presented for her first prenatal care visit at 26 weeks of gestation. Traditional two-dimensional (2D) ultrasonography suggested a singleton pregnancy complicated by anencephaly. Following medical termination, postnatal examination revealed an incidental parapagus diprospus dibrachius dipus twins with craniorachischisis totalis, characterized by two faces sharing a single head and neck. Single torso and umbilical cord, and totally exposed neural tissue from head to lower spine. Autopsy and MRI were not sent due to parental refusal on religious grounds. Conclusion This case underscores the limitations of two-dimensional ultrasonography in diagnosing complex congenital anomalies such as conjoined twins with craniorachischisis totalis. Late presentation during the second trimister due lack of early ultrasonographic evaluation at local health center and misdiagnosis as a singleton pregnancy at our hospital highlights the need for ultrasonographic modality along with trained personnels at local health facilities and heightened clinical vigilance and the potential value of three-dimensional ultrasound imaging at higher facilities in improving diagnostic accuracy and enabling timely informed parental decision-making, counseling, and perinatal management in uniformly fatal anomalies.