Rare Conjoined Twins Successfully Separated

Carter and Conner, conjoined twin boys born Dec. 2014, in Jacksonville, Fla., underwent a successful 12-hour separation surgery in May 2015.

The separation involved a 17-member surgical care team, including Stephen Dunn, MD, Division Chief of Solid Organ Transplant, for Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., who traveled to Jacksonville to assist the team in separating Conner and Carter’s fused livers.

Preparing for the Separation

Leading up to the surgery, the twins’ integrated care team spent months preparing for the complexities of this separation, including MRI studies, a medical illustration of the conjoined areas, clinical and logistical simulations of the final separation surgery and specific procedures, and keeping the boys as healthy and strong as possible considering their multiple medical challenges.

From the day after their birth to the morning of their final separation surgery, Carter and Conner received care in Wolfson Children’s Hospital’s Level III Neonatal Intensive Care Unit (NICU).

During their stay, the boys were cared for by nearly 200 health care professionals that included neonatal and pediatric critical care nurses, pediatric respiratory therapists, rehabilitation therapists, Child Life specialists, pediatric chaplains and other health care disciplines.

Before Separation Surgery

Immediately after their birth, the twins underwent emergency surgery to repair a potentially life-threatening condition called a ruptured omphalocele, in which their shared small intestine protruded through a weak area of the abdominal wall. The babies’ shared small intestine was inserted back inside their abdominal wall where a temporary mesh patch was placed over it to keep the bowel inside.

After that, the boys underwent an additional surgery to remove the temporary mesh where surgeons then partially separated the shared small intestine to enable the babies to feed orally. During the procedure, it was discovered that the boys had two bile ducts that also were fused. Conner and Carter’s livers and bile ducts were left intact for the May separation surgery.

From Birth to Separation

Carter and Conner were born on Friday, Dec. 12, 2014, to Michelle Brantley and fiancé Bryan Mirabal at UF Health Jacksonville at 11:14 pm. Although Michelle’s planned Caesarean section delivery was scheduled for Wednesday, Dec. 17, she went into labor and gave birth at 36 weeks. Father Bryan said that the identical and conjoined twins were born weighing a total of 10 lb., 2 oz. Conjoined twins are extremely rare, with estimates ranging from one in every 100,000 births to one in every 200,000 births.

Hope for the Future

Carter and Conner’s mother, Michelle, said, “We are so grateful to everyone who has taken care of our babies. We had so much confidence in them and they have been so good to us and to our family. We can’t wait to take Carter and Conner home!”