The First Case of Fetus in Fetu in Nicaragua: The Management Experience of the Pediatric Neurosurgery Team

Abstract

Fetus in fetu (FIF) is a rare congenital anomaly of asymmetric monozygotic twins, where the parasitic twin develops abnormally inside the body of the host twin. In most cases, it is incorporated into the sibling's abdomen, which frequently presents as a retroperitoneal mass. Currently, at least 200 cases have been reported worldwide, being this the first case in Nicaragua. We describe a case of a male newborn, born via cesarean section, with a history of multiple congenital malformations observed via ultrasound examination. At birth, a mass is observed on its dorsum that impresses a skull, but without the presence of bones, with three limbs, two upper and one lower, with an outline located transversely on the pelvic girdle and the presence of two male genitalia with agenesis of the testicles and an accessory kidney. A preoperative diagnosis of FIF and spinal dysraphism was made by computed tomography (CT) and magnetic resonance imaging (MRI). They shared a spinal cord and had the presence of an open spinal defect type meningocele with aberrant roots. After the diagnosis and discussion, the multidisciplinary team proceeded to surgery to perform the separation of the twin (FIF). The subsequent anatomopathological examination revealed that the fetus was anencephalic and had reliable FIF characteristics. The resection was performed followed by the closure of the 430 mL meningocele and complete separation of the spine and the parasitic twin. We present the first case of fetus in fetu in Nicaragua.

Fetus In Fetu With Myelomeningocele

“…The success of the resection is related to a multidisciplinary surgical intervention. 2 In our case, the participation of the pediatric neurosurgery team is fundamental for the patient’s prognosis due to their intervention in the closure of the thoracolumbar myelomeningocele.…”

“…Clinically, FIF can be distinguished from a teratoma by the presence of vertebrae and limbs. 2 Given that FIF grows in parallel with its host, surgical excision remains the primary treatment for this condition. with the removal of the fetus with its capsule.…”

“…Alpha-fetoprotein (AFP) or Beta-human chorionic gonadotropin (Beta-HCG) levels should be assessed in conjunction with imaging to identify any early indications of malignancy in the patient. 2…”

“…Notably, only a few cases, including those in the sacrococcygeal and thoracolumbar regions, have been documented. 1,2 In this report, we present an unusual case of FIF accompanied by spinal dysraphism in the dorsolumbar region, emphasizing the essential role of computed tomography (CT) and magnetic resonance imaging (MRI) in both diagnosis and evaluation.…”