Imagine this. You see a man entering a hospital with a bulging stomach. His friends teasingly say that he’s 'pregnant'. Doctors suspect it’s a tumour. But, when a surgery is performed, the doctors find bones, limbs, genitalia, hair, and jaws in the man’s abdomen. Turns out, he was indeed 'pregnant', or was as close to the definition of the term as humanly possible in a cis-gender male.
This actually happened. In 1999. In Nagpur. Now 60, Sanju Bhagat was operated upon after he lived with his twin brother in his belly for 36 whole years.
The case has now surfaced online, 24 years later, shocking many people on the internet.
Dr Ajay Mehta, who conducted the operation, told Daily Star, "To my surprise and horror, I could shake hands with someone inside. It was quite shocking for me."
But how is this even possible? How could a cis-male be 'pregnant'? And that too for 36 years? Read on to find out.
Foetus in Foetu: How A Man Got Pregnant
Bhagat was suffering from a rare condition called foetus in foetu – a sort of parasitic twin formation that occurs in one's abdomen. A 2008 study published in the Journal of Indian Association of Pediatric Surgeons defined it as the "presence of one of the twins in the body of the other."
The study added, “It is most frequently located in the retroperitoneal area; however, it has been reported in other locations as well.”
How did the twin get there?
Medically, foetus in foetu is a developmental abnormality, which is also an example of “vanishing twin syndrome.”
To simplify this a little, when a twin dies in the womb, the other twin usually absorbs the tissues. But in very rare cases like this one, one of the twins absorbs the other, and the body of the latter still keeps developing within the 'host twin'.
When we say rare, we mean rare.
According to a 2014 report published in the Journal of Surgical Case Reports, the chances of something like this happening are 1 in 5 lakh. Globally, fewer than 100 cases have ever been reported.
This was first defined by Johann Friedrich Meckel in the 18th century, as reported in the British Medical Journal. Up until 2019, foetus in foetu had been reported in only seven adults, all of them male. All the other cases had been reported in infants or minors.
In one such case, reported in the APSP Journal of Case Reports, an 18-month-old male child, who was anaemic and malnourished, had an abdominal swelling that kept increasing. It was "occupying the whole of the left half of the abdomen," the study had said.
A CT scan of the child showed "a large mass with variable solid and cystic consistency" that was "displacing the left kidney superolaterally and posteriorly along with spleen laterally."
The mass was 10x8x7 cm big and weighted 800 grams. The discomfort caused by the mass was such that it had to be operated upon.
The Host & Parasite Theories
Dr Deepa Giri, Consultant, Obstetrics & Gynecology, at Navi Mumbai’s Apollo Hospitals shares that there's not enough research as of now to understand why this happens. But there are certain theories about it.
"The parasitic twin theory says that the twins are conceived as one cell that breaks down into two. These are called monozygotic cells, which share a very similar blood flow, are of the same sex, and they start growing together individually. In the early phases itself, the host cell incorporates the other cell which becomes the parasite. This parasite cell might keep growing normally until the time of delivery."Dr Deepa Giri
She concurs that in the few cases that have been reported so far, it's been within a year or so of birth because the host baby would suffer from problems like frequent vomiting, indigestion, and abdominal problems.
Studies also suggest that in most of these cases, foetus in foetu has been detected through imaging or radiologically while in the preoperative period.
What Happened in Bhagat’s Case
Growing up, Bhagat ignored his bulging belly. But, according to Daily Star, his belly started “growing at an alarming rate” when Bhagat was in his 20s and was working at his farm.
At one point, his stomach started pressing against his diaphragm, which resulted in breathing troubles for him.
However, he was misdiagnosed at a Mumbai hospital. Doctors thought it was a tumour. During the operation, they found a human inside of Bhagat and had to surgically remove the entire mass.
Just like what happened in Bhagat’s case, the choice of treatment, in most cases, is "total excision," according to a study in the Annals of Surgery.
The study added, "Special attention (is) given to the foetus' blood supply which may be directly from the host's superior mesenteric vessels."
As of now, no other point of treatment exists apart from surgically removing the parasite twin. In some cases, because of the parasitic nature of the twin, and the pressure it puts on the host, the risk of mortality for the host increases.
If left as it is, foetus in foetu can further cause:
Haemorrhage
Infection
Mass effects
Pleuro-peritoneal inflammation
However, Bhagat's case was no less than a miracle with not just him surviving, but his 'parasitic twin' also continuing to stay on in his abdomen for many years.
As per a study, published in the Journal of Indian Association of Pediatric Surgeons which closely followed two case studies of infants' who had parasitic twins inside their abdomens, "heterogeneous mass lesions with a size of 10 × 7 × 6 cm in the retroperitoneal area" were found in their bodies when they were barely a few days old.
The good news, however, is that the post operative phase in a majority of such cases has been uneventful and normal. After the surgery, even Bhagat returned to a normal life, as do most people with foetus in foetu.
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