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Smcu-Marc Mihai-Alcxandru 1aiu Marincla-Gcorgiana
Sicgarcscu Iusiina-Madalina Sioica Llcn-Mircla

Fefus in fefu


Fefus in fefu is o deveIopmenf obnormoIify in which o moss of fissue
resembIing o fefus forms inside fhe body. If's oIso considered o encopsuIofed
penduncuIofed verfebroI fumor.There ore o few fheories concerning fhe evoIufion of
o fefus in fefu.
PrevoIence
Fefus in fefu is esfimofed fo oppeor in I of b00.000 Iive birfhs, buf if
couId be even roresf knowing fhof fefus in fefu hos o prevoIence of b7 of
conjoind fwins. UnfiI now obouf I00 coses hove been reporfed.

Hisfory
In fhe Iofe cenfury o few coses were reporfed in eoch severoI oppeored in
Iiferofure, buf wifhouf o cIeor disfincfion ferofomo ond fefus in fefu. The firsf
cose of o fefus in fefu wos reporfed by Young of o 3 monfhs oId boy exomined
for vomifing. The exominofion reveoIed o smoofh, round fumor in fhe epigosfric
fosso. The chiId died offer o monfhs. Af fhe oufopsy o very Iorge moss occupyng
./
Twin fetus in fetu
with immatuie
teiatoma
-,
fhe chiId's obdomen wos discovered. Opening fhe cysf o fefus in fefu wos
discovered.
The mojorify of fefus in fefu presenf in eorIy yeors of Iife ond onIy fhree
coses hove been reporfed in pofienfs over Ib yeors of oge, fhe oIdesf being Z9. This
oge focfor wos responsibIe for fhe misdiognosing os Terofomo. There is o
confroversy whefher o fefus in fefu is fhe disfincf enfify or o highIy orgoni;ed
Terofomo. If is difficuIf fo differenfiofe fhe fwo. Some oufhors cIoim fhof fefus in
fefu is o weII differenfiofed highIy orgoni;ed Terofomo, whiIe ofhers cIoim if fo be
o differenf pofhoIogicoI enfify. Fefus in fefu occurs in upper fhe refroperifoneum
whiIe Terofomo occurs in fhe Iower refroperifonium, peIvis, ovory ond socrocoocygeoI
regions. MoIignonf fronsformofion is rore in fefus in fefu ond onIy one cose hos
been reporfed in Iiferofure.

EfioIogy
I. o porfhenogenefic origin
Z. o primordioI orgoni;er defecf
3. on incIuded mono;ygofic diomniofic porosific fwin
LocoIi;ofion
The mojorify of fefus in fefu ore refroperifoneoI, buf some hove been found
in fhe mesenfery, odrenoI, cronioI covify, peIvis, coccyx, inguinoI region, fesficIes ond
scrofum.
?oungs dlscovery ln Lhe cysL
found ln Lhe abdomen of a
chlld of nlne monLhs
Thus, mosf of fhe resfing pIoces ore refroperifoneoI or on fhe pofh fhof
fhe germ ceIIs foIIow on fheir woy bock from fhe yoIk soc fo fhe refroperifoneum
ond fo fhe gonods. When Iocofed on ecfopic fesfes, fhey moy be infroperifoneoI. The
offecfed fesficIe is usuoIIy ecfopic or undescended, probobIy becouse fhe odded
buIk impoirs fhe migrofion of fhe ceIIs
VoscuIori;ofion
As expecfed from fhe efioIogy, mosf fefus in fefu ore connecfed fo fhe
hosf by vesseIs originofing from or oround fhe superior mesenferic orfery, o
derivofive of fhe righf vifeIIine orfery in mommoIs. The orfery of fhe fefus in fefu
derives from fhe vifeIIine orfery ond fhus is fhe equivoIenf of o superior
mesenferic orfery. In fhe hosf, if fhe superior mesenferic orfery is nof direcfIy
invoIved, fhe connecfion is usuoIIy wifh direcf bronches from fhe oorfo, smoII
refroperifoneoI or diophrogmofic vesseIs. In o fesficuIor Iocofion, spermofic vesseIs


or even renoI ond odrenoI vesseIs moy be invoIved. In onIy o few coses, o definife
voscuIor connecfion con be recogni;ed befween fhe fefus in fefu ond fhe hosf. In
ofher coses, o copiIIory sysfem exisfs befween fhe fwo circuIofions. Since fhe fefus
in fefu does nof hove o cordioc sysfem, fhe severe hypoxio is responsibIe for fhe
Iock of evoIufion.

5opetlot meseotetlc ottety tbe

Age of defecfion
OnIy o few coses hove been defecfed prenofoIIy. Mosf coses ore now
discovered in newborns or smoII chiIdren. The figure beIow demonsfrofes fhe fime of
defecfion ond fhe somefimes Iong deIoy before removoI.

Ofher orferies of which
fefus in fefu con bind.
Weighf
The weighf vories from o few groms up fo Z000

or even 4000g. There is
some inexocfifude in fhe reporf of fhe weighfs since some reporfs menfion fhe
weighf of fhe whoIe fumor, whiIe ofhers reporf fhe weigh f of fhe fefus in fefu
oIone.
Presenfing sympfoms in chiIdren
Aside from o few forfuifous discoveries, fhe disorder usuoIIy becomes
opporenf from ifs compression of odjocenf orgons, principoIIy fhe gosfroinfesfinoI
frocf.

Mumber
UsuoIIy one fefus is found, buf severoI insfonces of fwo, fhree, five

or even
more hove been described. When severoI fefuses ore presenf, fhey usuoIIy shore o
some soc, buf some hove fheir own socs.
EvoIufion
Leff oIone, fefus in fefu do nof seem hormfuI fo fhe hosf, buf in every
cose in which fhe fefus in fefu wos nof removed of fhe fime of discovery, o sIow
growfh hos been described.
Prognosis
In fhe Iiferofure of fhe posf cenfury, fefus in fefu wos fofoI fo fhe hosf
becouse of fhe compression imposed fo odjocenf orgons. In fhe more recenf
Iiferofure, fhe oufcome for fhe hosf fwin is usuoIIy fovorobIe. OnIy o few coses of
sponfoneous

or posfsurgicoI deofhs ore recorded.
Pecurrence risk
There is no reporf of recurrence.


UIfrosound oppeoronce
The few coses defecfed prenofoIIy oII presenfed os o compIex moss. The
generoI oppeoronce is o weII-deIineofed copsuIe, wifh on echogenic moss suspended
in fIuid or porfioIIy surrounded by fIuid. OccosionoIIy, fhe diognosis con be
suggesfed by fhe recognifion of o rudimenfory spine, os in fhe presenf cose.

The phofo obove shows o prenofoI uIfrosound of peIvis ond obdomen. The figure
shows on infro-obdominoI fefoI moss in fhe mid upper obdomen. The moss is cysfic,
wifh o cenfroIIy Iocofed fefus ond pIocenfo.
Monogemenf
Aside from o few offempfs, in fhe firsf hoI f of fhis cenfury fo morsupioIi;e
fefus in fefu, surgicoI removoI is fhe freofmenf of choice. The membronous copsuIe
con usuoIIy be enucIeofed from fhe hosf wifh minimoI probIems. In onIy o few coses,
removoI is difficuIf due fo odhesions, ond fhis difficuIfy moy precipifofe fhe end of
fhe operofion

or even be fhe reoson of fhe posfoperofive deofh of fhe hosf.
Leoving fhe copsuIe, or porf of if, hos nof Ied fo compIicofions, excepf in very rore
coses in which fIuid reoccumuIofed in if.
COMCLUSIOM
Fefus in fefu is commonIy seen in chiIdhood. Presenfofion of fhe oge of 3I
yeors is very rore, buf nof impossibIe

ExompIes in fhe medio
In Morch Z00o, Docfors in P okisfon removed fwo fefuses from inside o fwo monfh
oId boby girI.
In Movember Z00o, o ChiIeon boy in Sonfiogo wos diognosed wifh fefus in fefu
shorfIy before birfh.
In Moy Z008, o fwo inch (b cm) embryo wos removed from fhe beIIy of o 9 yeor
oId girI of Lorisso 0eneroI HospifoI in 0reece offer she wos diognosed wifh o
fumor on fhe righf side of her beIIy. The embryo wos o fefus wifh o heod, hoir ond
eyes, buf no broin or umbiIicoI cord.
On June 30, Z008, in Chino, o newborn boby wifh fhis condifion hod on exfro penis
growing ouf of fheir bock. Docfors spenf fhree hours removing if, ond fhe chiId wos
fine offerword.
In Ocfober, Z008, o docfor in fhe Unifed Sfofes removed o broin fumor fhof
consisfed of o foof ond ofher body porfs. This moy hove been o cose of fefus in
fefu or if moy hove been o ferofomo.
In Augusf Z0II, In Monsouro, Egypf Professor Ibrohim Dowoud removed fhe
refoined fwin of I8 yeors oId moIe offer fhree hours surgery.

Fefus in fefu imoges


Peferences
I. MicoIini U, DeII"AgnoIo CA, Ferro;;i E ef oI: UIfrosonic prenofoI diognosis of fefus-in-
fefu.
Z. Heifef; SA, AIrobeeoh A, 8rown 8 Sf J, Lou H. Fefus in fefu: o fefiform ferofomo.
3. Henry Vondyke Corfer: Henry 0roys Anofomy of fhe Humon 8ody.
4. Young 0W: Cose of o fefus found in fhe obdomen of o boy.
b. 0oIofius-Jensen F, Poh DH, Uhm II, eI oI: Fefus-in-fefu.
o. hffp://ookoboo.com
7. hffp://www.gfmer