title: Hepatobiliary anomalies in conjoined twins.
abstract: BACKGROUND
  Conjoined twinning is an extremely rare anomaly. Very few diagrammatic descriptions are provided for the various hepatobiliary anomalies seen in these twins. We aimed to review our experience with the various subtypes of hepatobiliary anomalies and their association with the inability to separate as well as provide diagrammatic descriptions of these anomalies.
  
  
  METHODS
  We retrospectively reviewed our experiences within separating twins. We reviewed patterns of hepatobiliary anomalies and the required investigations and intraoperative workups.
  
  
  RESULTS
  Of the 60 cases we evaluated, 28 were successfully separated. The reasons for nonseparation were possession of: a single heart, major communicating hearts, or major chromosomal anomalies. The liver was involved in 17 cases (60.7%) in the operative group and 23 cases (71.8%) in the nonoperative group. All cases had a computed tomographic scan and ultrasound as preoperative workup. Only 2 cases required a magnetic resonance cholangiopancreatography for preoperative evaluation. Intraoperative ultrasound was not used, and only 3 cases required an intraoperative cholangiogram. Diagrammatic depictions of the various categories of anomalies are presented.
  
  
  CONCLUSIONS
  In our experience, we did not find hepatobiliary anomalies to be the sole reason for inseparability in any of the conjoined sets. Hepatobiliary anomalies seem to be more frequent in the nonseparable group.
authors: Department of Epidemiology and Biostatistics, College of Public, Health, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490 Riyadh 11426 Kingdom of Saudi Arabia.
authors: Abdullah
authors: A
authors: Al-Rabeeah
authors: Mohammed
authors: M
authors: Zamakhshary
authors: Mohammed
authors: M
authors: Al-Namshan
authors: Saud
authors: S
authors: Al-Jadaan
authors: Hesham
authors: H
authors: Alshaalan
authors: Aayed
authors: A
authors: Al-Qahtani
authors: Ibraheem
authors: I
authors: Alassiri