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Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital

Received: 30 September 2021     Accepted: 19 October 2021     Published: 28 October 2021
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Abstract

Fetus in fetus (FIF) is an extremely rare congenital condition characterized by the parasitic development of a malformed fetal twin within a normal second twin’s body. The localization is mostly abdominal in the retroperitoneum. Thoracic localization is extremely rare. In this clinical case, a 5 month old female infant weighing 5 kg presented with a chest mass causing respiratory distress. We realized a chest CT-Scan; the latter revealed a heterogeneous mass, completely occupying the left hemithorax. Imaging studies confirmed the presence of the fetus in fetus occupying the entire left hemithorax and mediastinum, pushing the heart to the right. A complete resection of the mass could be performed under general anesthesia and orotracheal intubation (GA + OTI). The monitoring involved ECG, SpO2, NIBP, PR, T°, and Capnometry. The ventilation was first mechanical and secondarily manual. The patient did not receive unipulmonary ventilation nor central IV line. Postoperative period marked by volume overload, anemia, cardiac arrest, with successful resuscitation. Histopathology studies and imaging confirmed the diagnosis. On D9, she was discharged from pediatric critical care and from hospital on day ten postoperative. She presented in good clinical condition after a 3-month follow-up. We report this case in order to show how we took care of this FIF case in the precarious conditions.

Published in American Journal of Pediatrics (Volume 7, Issue 4)
DOI 10.11648/j.ajp.20210704.13
Page(s) 198-202
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Fetus in Fetus, Chest Mass, Anesthetic Management, Infant

References
[1] Sitharama SA, Jindal B, Vuriti MK, Naredi BK, Krishnamurthy S, Subramania DB. Fetus in Fetu: Case Report and Brief Review of Literature on Embryologic Origin, Clinical Presentation, Imaging and Differential Diagnosis. Pol J Radiol. 2017; 82: 46-49.
[2] Lord JM. Intra-abdominal foetus in foetu. J Pathol Bacteriol 1956; 72: 627-41.
[3] Lindsey M. Prescher, William J. Butler, Tyler A. Vachon, Marion C. Henry, Thomas Latendresse, Romeo C. Ignacio Jr. Fetus in fetu: Review of the literature over the past 15 years; Journal of Pediatric Surgery CASE REPORTS, J Ped Surg Case Reports 3 (2015) 554-562.
[4] Reddy RK, Kannaiyan L, Srirampur S, Malleboyina R, Irfan GM, Sharab H, Kannepalli S. Thoracic fetus in fetu. J Indian Assoc Pediatr Surg. 2012; 17 (4): 178-9.
[5] Hoeffel CC, Nguyen KQ, Phan HT, Truong NH, Nguyen TS, Tran TT, et al. Fetus in fetu: a case report and literature review. Pediatrics 2000; 105: 1335-44.
[6] Phatak. Fetus-in-fetu: a case report. Indian J Radiol Image 2003; 13: 93-4.
[7] Barrier G, Mayer MNB, Amiel-Tison C et al. Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system; Intensive Care Med 1989; 15: 37-9.
[8] Escobar MA, Rossman JE, Caty MG. Fetus-in-fetu: report of a case and a review of the literature. J Pediatr Surg 2008; 43: 943-6.
[9] Hing A. Corterville J. Foglia RB, Bliss Jr DP, Dollis – Keller H, Dowton SB. fetus in fetu: molecular analysis of a fetiform mass. Am J Med Genet 1993; 47: 333-41.
[10] Grosfeld JL, Stepita DS, Nance WE, Palmer CG. Fetus in fetu: An usually cause for abdominal mass in infancy. Ann Surg 1974; 180: 80-4.
[11] Khadaroo RG, Evans MG, Honore LH, Bhargava R, Phillipos E. Fetus in fetu pressing as cystic meconium peritonitis: diagnosis, pathology, and surgical management. J Pediatr Surg 2000; 35: 731-3.
[12] Chua JH, Chui CH, Sai Prasad TR, Jabcobsen, AS, Meenakshi A, Hwang WS. Fetus in fetu in the pelvis: report of case and literature review. Ann Acad Med Singapour 2005; 34: 646-9.
[13] Kim JW, Park SH, Park SS, Wang KC, Cho BK, Kim SY, and al. Fetus in fetu in the cranium of a 4 month-old boy: histopathology and short tandem repeat polymorphism- based genotyping. Case report. J Neurosurg Pediatr 2008; 1: 410-4.
[14] Spencer R. Parasitic conjoined twins: external, internal (fetuses in fetu and teratomas), and detached (acardiacs). Clin Anat 2001; 14: 428-44.
[15] Ji Y, Chen S, Zhong L, Jiang X, Jin S, Kong F, Wang Q, Li C, Xiang B. Fetus in fetu: two case reports and literature review. BMC Pediatr. 2014; 14: 88.
Cite This Article
  • APA Style

    Joseph Akodjènou, Abdel-Kémal Bori Bata, Antoine Séraphin Gbénou, Médard Guedenon, Morgiane Houngbadji, et al. (2021). Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital. American Journal of Pediatrics, 7(4), 198-202. https://doi.org/10.11648/j.ajp.20210704.13

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    ACS Style

    Joseph Akodjènou; Abdel-Kémal Bori Bata; Antoine Séraphin Gbénou; Médard Guedenon; Morgiane Houngbadji, et al. Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital. Am. J. Pediatr. 2021, 7(4), 198-202. doi: 10.11648/j.ajp.20210704.13

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    AMA Style

    Joseph Akodjènou, Abdel-Kémal Bori Bata, Antoine Séraphin Gbénou, Médard Guedenon, Morgiane Houngbadji, et al. Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital. Am J Pediatr. 2021;7(4):198-202. doi: 10.11648/j.ajp.20210704.13

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  • @article{10.11648/j.ajp.20210704.13,
      author = {Joseph Akodjènou and Abdel-Kémal Bori Bata and Antoine Séraphin Gbénou and Médard Guedenon and Morgiane Houngbadji and Eulalie Sansuamou and Maroufou Jules Alao and Eugène Zoumènou and Jean Etienne Bazin and Francis Veyckemans},
      title = {Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital},
      journal = {American Journal of Pediatrics},
      volume = {7},
      number = {4},
      pages = {198-202},
      doi = {10.11648/j.ajp.20210704.13},
      url = {https://doi.org/10.11648/j.ajp.20210704.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210704.13},
      abstract = {Fetus in fetus (FIF) is an extremely rare congenital condition characterized by the parasitic development of a malformed fetal twin within a normal second twin’s body. The localization is mostly abdominal in the retroperitoneum. Thoracic localization is extremely rare. In this clinical case, a 5 month old female infant weighing 5 kg presented with a chest mass causing respiratory distress. We realized a chest CT-Scan; the latter revealed a heterogeneous mass, completely occupying the left hemithorax. Imaging studies confirmed the presence of the fetus in fetus occupying the entire left hemithorax and mediastinum, pushing the heart to the right. A complete resection of the mass could be performed under general anesthesia and orotracheal intubation (GA + OTI). The monitoring involved ECG, SpO2, NIBP, PR, T°, and Capnometry. The ventilation was first mechanical and secondarily manual. The patient did not receive unipulmonary ventilation nor central IV line. Postoperative period marked by volume overload, anemia, cardiac arrest, with successful resuscitation. Histopathology studies and imaging confirmed the diagnosis. On D9, she was discharged from pediatric critical care and from hospital on day ten postoperative. She presented in good clinical condition after a 3-month follow-up. We report this case in order to show how we took care of this FIF case in the precarious conditions.},
     year = {2021}
    }
    

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    T1  - Anesthetic Management of an Intrathoracic Fetus in Fetus Case in a 5 Months Old Infant at a Low Resources African Sub-saharan Hospital
    AU  - Joseph Akodjènou
    AU  - Abdel-Kémal Bori Bata
    AU  - Antoine Séraphin Gbénou
    AU  - Médard Guedenon
    AU  - Morgiane Houngbadji
    AU  - Eulalie Sansuamou
    AU  - Maroufou Jules Alao
    AU  - Eugène Zoumènou
    AU  - Jean Etienne Bazin
    AU  - Francis Veyckemans
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    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajp.20210704.13
    DO  - 10.11648/j.ajp.20210704.13
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 198
    EP  - 202
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20210704.13
    AB  - Fetus in fetus (FIF) is an extremely rare congenital condition characterized by the parasitic development of a malformed fetal twin within a normal second twin’s body. The localization is mostly abdominal in the retroperitoneum. Thoracic localization is extremely rare. In this clinical case, a 5 month old female infant weighing 5 kg presented with a chest mass causing respiratory distress. We realized a chest CT-Scan; the latter revealed a heterogeneous mass, completely occupying the left hemithorax. Imaging studies confirmed the presence of the fetus in fetus occupying the entire left hemithorax and mediastinum, pushing the heart to the right. A complete resection of the mass could be performed under general anesthesia and orotracheal intubation (GA + OTI). The monitoring involved ECG, SpO2, NIBP, PR, T°, and Capnometry. The ventilation was first mechanical and secondarily manual. The patient did not receive unipulmonary ventilation nor central IV line. Postoperative period marked by volume overload, anemia, cardiac arrest, with successful resuscitation. Histopathology studies and imaging confirmed the diagnosis. On D9, she was discharged from pediatric critical care and from hospital on day ten postoperative. She presented in good clinical condition after a 3-month follow-up. We report this case in order to show how we took care of this FIF case in the precarious conditions.
    VL  - 7
    IS  - 4
    ER  - 

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Author Information
  • Resuscitation Anesthesia Department, Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Pediatric Surgery Department Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Pediatric Surgery Department Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Pediatric Surgery Department Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Pediatric Department, Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Radiology Department, Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Pediatric Department, Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Resuscitation Anesthesia Department, Mother and Child Teaching Hospital Lagoon, Abomey-Calavi University, Cotonou, Benin

  • Resuscitation Anesthesia Department, Estaing University Hospital Center, Clermont, Ferrand, France

  • Resuscitation Anesthesia Department, Regional University Hospital Center, Lille, France

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