Surgical management of pygopagus parasiticus in a developing country: Challenges and review of the literature

•Conjoined twins are uncommon, parasitic twins are rare.•Adequate pre-operative planning essential to successful separation.•Treatment is almost always multidisciplinary, care givers must be allies.•Challenges include limited surgeons' experience, poor health insurance coverage.•Cultural taboo/superstition/risk of abandonment/homicide of patient - real threats.

Conjoint twins are a rare aberration of monozygotic twinning which could be symmetric or asymmetric. Pygopagus parasiticus is a form of asymmetric twinning in which the parasitic or incomplete twin is attached to the autosite (dominant twin). We present our recent experience in the management of a case of pygopagus parasiticus highlighting the challenges peculiar to developing economies such as ours and how such challenges could be surmounted.