Incomplete conjoined twinning or heteropagus attached at the autosite's epigastrium is an extremely rare form of conjoined twinnings. We report a case of epigastric parasitic twinning in which the parasite has a well developed lower trunk and pelvis with rudimentary lower limbs, and well developed upper extremities without shoulder girdles and thoracic cage. The clinical features of this rare entity are discussed with a literature review. We emphasize that in spite of monstrous appearance, autosite component of epigastric heteropagus can be treated successfully with minor surgery. This fact should be kept in mind during the intrauterine evaluation of these type of anomalies in order to avoid needless terminations.
Background: Although postoperative hemorrhage after thoracic surgery is uncommon, it is the most common indication for revision surgery after these procedures. Most postoperative hemorrhages are due to surgical technique, although some comorbidities can predispose the patient to bleeding. We investigated whether video-assisted thoracoscopic surgery (VATS) and re-thoracotomy had the same outcomes in the management of postoperative hemorrhage in patients who underwent open thoracotomy or VATS. Materials and Methods: We retrospectively analyzed patients with postoperative hemorrhage after thoracotomy (n = 659) or VATS (n = 883) between 2018 and 2020. Revision surgery was performed after thoracotomy in 22 patients (3.3%) and after VATS in 4 patients (0.4%). Of these, 11 patients (42.3%) were re-operated by re-thoracotomy (Re-thoracotomy Group) and 15 patients (57.7%) by revision VATS (VATS Group).Results: Revision due to postoperative hemorrhage was required significantly more frequently after thoracotomy than VATS (3.3% vs. 0.4%, p < 0.001). In patients with hemorrhage after pneumonectomy (n = 14), revision by VATS was preferred to re-thoracotomy (n = 10, 71.4% vs. n = 4, 28.6%). The mean time to discharge after revision surgery was 5.1 ± 2.2 days (range, 2-12 days) overall and was significantly shorter in the revision VATS Group than in the Re-thoracotomy Group (4.4 ± 1.5 days vs. 6.2 ± 2.5 days, p = 0.004).Conclusions: VATS has similar results to re-thoracotomy and is advantageous in terms of earlier recovery and shorter hospital stay. Therefore, VATS should be the preferred method for postoperative hemorrhage management.
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