Unborn twin dey live as parasite inside baby abdomen

Wen Dr Mushtaq Ahmed operate on 10-month-old baby Shazia to remove a suspected cyst, e dey shock to see pair of half-formed feet for her belle.

"My team dey expect to find a cyst or abdominal mass in dis little baby girl wey bin dey cry in pain for months. But as we open di baby abdomen and I begin see toes and a spine, I no fit tok for a moment.

"I never come across a case like dis for my 15 years wey I be paediatric surgeon."

As im dey describe di incredible discovery, Dr Mushtaq say im team realise say dem dey look di baby Shazia unborn twin foetus. Na probably eight to nine weeks old wen e stop to develop.

"We clearly see di beginnings of all four limbs, wit di toes wey dey easily visible, and we even fit see feature wey resemble eyes."

Di surgery to remove di foetus dey performed for Pakistan, for Sheikh Zayed teaching hospital in Rahim Yar Khan, in di southern Punjab region.

Fetus in fetu

For di world of medicine, dis rare condition dey known as "fetus in fetu", wen a malformed parasitic foetus dey located inside di body of twin.

E no get any known trigger, but di condition occur in di early stage of development, wen one foetus wrap around di oda.

Di twin wey dey enveloped no dey fully form, but e go become a "parasite", wey dey rely on dia host twin for survival. Such twins dey usually die bifor birth.

Di abnormality dey estimated to occur for one per 500,000 live births, according to one American Academy of Paediatrics report in 2000.

Fewer dan 200 cases of di anomaly dey reported worldwide.

Excessive crying

Baby Shazia stomach start to dey swell a month afta dem born her. Her parents say she begin cry for long periods, inside pain.

"We no know wetin di problem be, but her stomach dey hard to touch", Shazia father, Muhammed Asif tok.

A low-wage labourer wey dey rear cattle on a farm, Asif and im wife, along wit dia two oda children, carry Shazia to several doctors for dia home town of Sadiqabad. However, lack of medical facilities and say di disease dey rare, her condition come remain undiagnosed.

Wen Shazia condition become unbearable, on 25 August, dem decide to travel 30km to di better-equipped Sheikh Zayed Hospital for Rahim Yar Khan. A few hour later dey meet Dr Mushtaq.

"Wen I examine di baby, I feel one tumour of some sort. I do ultrasound and [diagnose] say e get some sort of cyst for di abdomen. My mind no consider di idea say e fit be anytin else."

Di parents no fit afford MRI scan, wey suppose provide a more accurate diagnosis. Dr Mushtaq advise say removing di cyst by surgery na di best option.

"Dat make dem fear - dem no understand why baby wey dey so young go need to do surgery, and di situation overwhelm dem."

Shazia parents no gree for di surgery and dem carry her go back house.

But dem return afta few days, as dem dey desperate for anytin wey go help dia daughter wey don dey extremely distressed.

"Di family dey so poor and living in bad condition, so our unit bin give dem a big discount to help pay for di surgery," Dr Mushtaq explain.

On 29 August, during surgery, di moment di team make di shocking discovery of Shazia unborn twin. Dem realise say dem gatz carry out di delicate operation to comot am.

"We dey astonished to find dis malnourished baby dey carry her twin foetus."

Di foetus don dey act as parasite - as e gum join one of di baby smaller intestines, wia e come dey draw blood, and dat dey deny essential nutrients to Shazia.

Dr Mushtaq report say Shazia recover immediately afta di surgery and she don dey grow strong.

"She stop to dey cry and we observe say her condition don improve since di operation."

dem discharge Shazia from hospital on 4 September, four days afta di surgery. Her paediatric care team plan to do follow up ontop her condition in di coming weeks, and submit her case and dia findings to one science journal.

Baby 'pregnancy' rumours

Due to di matter wey dey very rare, na different intense media interest dey for Shazia tori. Her papa even switch off im mobile phone to avoid answering questions wey dey disturbing.

"Newspapers and [TV] channels dey call to find out if we dey deal wit a baby pregnancy and dem ask us all sort of questions wey dey very alarming," e tok.

Di hospital team say e don provide clarification to local journalists and counselling to Shazia parents, wey dey distressed by questions around di false reports of 'pregnancy'.

Di head of di Paediatric Surgery department at di Pakistan Institute of Medical Sciences (PIMS) for di capital Islamabad, Dr Nadeem Akhtar, dey keen to stress say di fetus in fetu condition no dey related to pregnancy.

"Many journalists dey embellish dis kind of story, to connect am to pregnancy becos dem no understand di condition. Den, families of victims dey vex," Professor Akhtar tok.

"Dis foetus-like mass no dey always get di ability to grow or spread throughout di body, like in di way a pregnancy or a tumour go dey. E dey usually stay for wia e form, plenti times na around di lower abdomen.

Oda cases of fetus in fetu

One widely reported case na dat of a 36-year-old man for India wey im suspected tumour don grow so big dat im dey get difficulty to breath.

Doctors operate am afta im complain of severe abdominal pain, im dey expect to find a large tumour - but dem discover a large mass consisting of di half-formed body of im unborn twin brother.

Di trapped foetus don survive so long as e dey act as a parasite, forming an umbilical cordlike structure wey dey take blood from di man blood supply.

Doctors say e dey possible make someone no dey aware say dem get foetus inside dem if dey live for villages or smaller towns, wia access to medical facilities dey limited.