PURPOSE: Conjoined twins are a rare complication of 9 monozygotic twins and are 
associated with high perinatal mortality. Pygopagus are one of the rare types of 
conjoined twins with only a handful of cases reported in the literature. We 
present the case of one-and-half month-old male pygopagus conjoined twins, who 
were joined together dorsally in lower lumbar and sacral region and had spina 
bifida and shared a single thecal sac with combined weight of 6.14 kg. Spinal 
cord was separated at the level of the conus followed by duraplasty. They had 
uneventful recovery with normal 15 months follow-up.
CONCLUSION: Separation of conjoined twins is recommended in where this is 
feasible with the anticipated survival of both or one infant.