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The development of conjoined twins always catches the eyes of researchers and clinicians. Beyond the rareness of the cases, how they develop is a debatable issue. This report presented a case of ischiopagus conjoined twins who had two heads (dicephalus), four upper extremities (tetrabrachius), and were joined below the chest with two lower extremities (bipus). The twin's mother was referred from a primary hospital to Dessie Comprehensive Specialized Hospital for proper management of twin pregnancy, where a cesarean section was performed.
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