Feto In Fetu

Mustafa et al, Fetus in fetu

C ASE R EPORT

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A Case of Fetus in Fetu
Ghulam Mustafa,* Bilal Mirza, Shahid Iqbal, Afzal Sheikh

ABSTRACT Fetus in fetu is a rare developmental aberration, characterized by encasement of partially developed monozygotic, diamniotic, and monochorionic fetus into the normally developing host. A 4-month-old boy presented with abdominal mass.Radiological investigations gave the suspicion of fetus in fetu. At surgery a fetus enclosed in an amnion like membrane at upper retroperitoneal location was found and excised. The patient is doing well after the operation. Key words: Fetus in fetu, Teratoma, Abdominal mass

INTRODUCTION

CASE REPORT

Fetus in fetu (FIF) is an uncommon pathology that results due to abnormal embryogenesis in adiamniotic monochorionic twin pregnancy with an incidence of 1 in 500000 births. The commonly accepted theory states that unequal division of blastocoele results in monozygotic, monochorionic, and diamniotic twins of unequal sizes following which the smaller twin encases into the normally developing twin; the mechanism of which is not known. This is followed by arrest of further growth of the encasedfetus due to improper blood supply or inherent defects of the encased twin. Few authors consider FIF as an advanced form of teratoma [1-3]. We report another case of fetus in fetu diagnosed preoperatively with the help of radiological investigations.
Affiliation: Department of Paediatric Surgery, The Children's Hospital and the Institute of Child Health Lahore, Pakistan. Address forcorrespondence:* Dr. Ghulam Mustafa, Department of Paediatric Surgery, The Children's Hospital and the Institute of Child Health Lahore, Pakistan. E-mail address: missyou009@yahoo.com Received on: 14-03-2012 http://www.apspjcaserep.com Accepted on: 12-04-2012 © 2012 Mustafa et al.

A 4-month-old male baby presented to our hospital with the complaint of palpable mass in the right hemi-abdomen noted by theparents one day back. The patient was born at full term with uneventful birth history. The baby achieved milestones normally. Abdominal examination revealed a non-tender mass with vague margins in the right hemi-abdomen. Laboratory investigations including alpha-fetoprotein were within normal limits. X-ray abdomen showed mass impression pushing the gut shadows to one side. Bones and calcificationswere also evident in the right hemi-abdomen. Ultrasound of the abdomen revealed a heterogeneous mass with calcifications suggestive of teratoma. Abdominal CT scan showed a 9.2cm × 10.0cm heterogeneous mass containing fat, bones and soft tissues. The various bones were vertebrae, long bones like femur, tibia and fibula, and bones of hand/feet (Fig.1). Provisional diagnosis of FIF was made. Atoperation, a mass covered in whitish-gray membrane, pushing the gut loops to the opposite side in the upper retroperitoneum, was found (Fig.2). The membrane was incised to find a fetiform mass floating in clear fluid having a few well differentiated and other rudimentary organs. The fetiform mass was suspended in the amnion like cavity with an umbilical cord like stalk (Fig.3). The mass with sac was mobi-This work is licensed under a Creative Commons Attribution 3.0 Unported License Competing Interests: None declared Source of Support: Nil

APSP J Case Rep 2012; 3: 9

Mustafa et al, Fetus in fetu

lized and excised completely. Post operative recovery was uneventful. Patient was allowed orally on 3rd and discharged on 7th post operative day. The

patient is currently being followedwith alphafetoprotein and ultrasound abdomen. At six months follow up patient is doing well.

Figure 1: CT scan showing various kind of bones in FIF.

lia that lacked gonad in it. The FIF also lacked anus and genitalia (Fig.4). Plain radiography of the specimen revealed axial skeleton in the form of vertebrae, along with ribs, long bones of upper and lower limbs, and facial bones (Fig.5)....