The twins were unable to sit up during the first three years of their lives.
Conjoined twin boys who share one bladder, rectum, and intestine are a one in two million phenomenon, a medical journal has revealed.
The Ischiopagus Tripus conjoined twins from Indonesia were born in 2018 with three legs, four arms, and one penis, but their rare case has only just been reported on by the American Journal of Case Reports.
The two three-year-old toddlers were unable to sit up during the first three years of their life.
But a team of surgeons amputated their third leg and stabilised their hip and pelvic bone so they could sit upright.
It is unknown how long the surgery took on the twins but there were no complications.
Doctors said one of the twins had an underdeveloped kidney, known as left kidney hypoplasia, while the other only had one kidney.
The twins have two older siblings and there is no family history of any other medical issues.
The twins are joined together like a ‘spider’ – a term coined from the famous case of conjoined twins Ganga and Jamuna Mondal of India.
Conjoined twins develop when an early embryo only partially separates to form two individuals.
Although two babies develop from this embryo, they remain physically connected — most often at the chest, abdomen or pelvis.
Conjoined twins may also share one or more internal body organs and account for one in 50,000 to 200,000 live births.
Out of these, only six to 11% of conjoined twins are Ischiopagus – which is twins born joint at the pelvis.
In two-thirds of cases at least one twin either dies or is stillborn.
In 1992, doctors also managed to separate two conjoined twins in China who had two normally functioning arms, two working legs, and one nonresponsive fused leg. The boys also had one penis and two testes but no anus.
The surgery to separate the two-year-olds took just over 10 hours to complete.
Another pair of twins from 2011 were fused together at the lower half of their bodies, and one twin was significantly smaller, more feeble, and had a smaller head.
The twins’ genitalia was not developed enough to assign a gender at birth and there was no clear anus and both died before they could be separated.
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