Parasitic rachipagus associated with complex spinal dysraphism: A case report.
- 1Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Abstract
Background
Rachipagus is an exceptionally rare form of parasitic conjoined twinning characterized by dorsal fusion along the vertebral column and is frequently associated with spinal dysraphism. The coexistence of complex dysraphic anomalies and mature teratomatous differentiation is exceedingly uncommon and may complicate the distinction between parasitic rachipagus and mature teratoma. We report a rare case highlighting the diagnostic challenge and surgical management of this unusual entity.Case description
An 8-month-old girl presented with a progressively enlarging congenital midline dorsal mass containing paired rudimentary limb-like appendages. Neurological examination was normal. Computed tomography demonstrated thoracolumbar spinal dysraphism, while magnetic resonance imaging revealed lipomyelomeningocele, type II split cord malformation (diastematomyelia), and tethered cord. Complete excision of the parasitic mass with surgical repair of the associated spinal dysraphism was successfully performed. Histopathological examination demonstrated mature adipose, fibrous, cartilaginous, and osseous tissues consistent with mature teratomatous differentiation. However, the characteristic clinical morphology, radiological findings, and intraoperative findings supported the diagnosis of parasitic rachipagus. The postoperative course was complicated by wound dehiscence requiring revision surgery. At 1-year follow-up, the patient remained neurologically intact with preserved bladder and bowel function.Conclusion
This case expands the limited literature on parasitic rachipagus associated with complex spinal dysraphism. Mature teratomatous differentiation does not exclude the diagnosis of parasitic rachipagus, which should be established through integration of clinical, radiological, intraoperative, and histopathological findings rather than histopathology alone. Complete excision combined with appropriate neurosurgical management can achieve favorable long-term outcomes.
Related
- Perioperative shear wave elastography for the evaluation of spinal cord release in pediatric dysraphism: first experience in 21 patients
- Be aware of the tuft of hair: traumatic lumbar intradural hematoma following spinal anesthesia in a case of occult spinal dysraphism. Illustrative case
- Conus hematoma following spinal anesthesia in an unrecognized case of occult spinal dysraphism: Lessons from a rare but preventable iatrogenic injury.
- Cancer-Associated Parasitic Neglected Tropical Diseases: Precision Diagnostics, Risk Stratification, and Implementation Priorities
- From raw to scaled human spinal cord morphometry: An original system for identifying complex anatomical patterns
BibTeX
@article{budirahaji2026parasitic,
title = {{Parasitic rachipagus associated with complex spinal dysraphism: A case report.}},
author = {Ahmad Budirahaji and Wihasto Suryaningtyas and Muhammad Arifin Parenrengi},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_914_2026},
url = {https://europepmc.org/article/MED/42974291},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Parasitic rachipagus associated with complex spinal dysraphism: A case report.
AU - Ahmad Budirahaji
AU - Wihasto Suryaningtyas
AU - Muhammad Arifin Parenrengi
PY - 2026
DA - 2026/10/23
JO - Surgical neurology international
DO - 10.25259/sni_914_2026
UR - https://europepmc.org/article/MED/42974291
AB - Background Rachipagus is an exceptionally rare form of parasitic conjoined twinning characterized by dorsal fusion along the vertebral column and is frequently associated with spinal dysraphism. The coexistence of complex dysraphic anomalies and mature teratomatous differentiation is exceedingly uncommon and may complicate the distinction between parasitic rachipagus and mature teratoma. We report a rare case highlighting the diagnostic challenge and surgical management of this unusual entity.Case description An 8-month-old girl presented with a progressively enlarging congenital midline dorsal mass containing paired rudimentary limb-like appendages. Neurological examination was normal. Computed tomography demonstrated thoracolumbar spinal dysraphism, while magnetic resonance imaging revealed lipomyelomeningocele, type II split cord malformation (diastematomyelia), and tethered cord. Complete excision of the parasitic mass with surgical repair of the associated spinal dysraphism was successfully performed. Histopathological examination demonstrated mature adipose, fibrous, cartilaginous, and osseous tissues consistent with mature teratomatous differentiation. However, the characteristic clinical morphology, radiological findings, and intraoperative findings supported the diagnosis of parasitic rachipagus. The postoperative course was complicated by wound dehiscence requiring revision surgery. At 1-year follow-up, the patient remained neurologically intact with preserved bladder and bowel function.Conclusion This case expands the limited literature on parasitic rachipagus associated with complex spinal dysraphism. Mature teratomatous differentiation does not exclude the diagnosis of parasitic rachipagus, which should be established through integration of clinical, radiological, intraoperative, and histopathological findings rather than histopathology alone. Complete excision combined with appropriate neurosurgical management can achieve favorable long-term outcomes.
SN - 2229-5097
SN - 2152-7806
ER -