Conjoined twins in Cameroon: a single-centre case series highlighting the burden of care in Central Africa.

PURPOSE: Conjoined twins are rare congenital anomalies associated with high mortality, particularly in low-resource settings. We report our 19-year experience at a single paediatric surgery centre in Cameroon, describing the epidemiological, clinical, and therapeutic characteristics of this condition. METHODS: This was a retrospective descriptive case series including all conjoined twins managed at our institution between August 2005 and August 2025. Epidemiological, clinical, diagnostic, therapeutic, and outcome data were analysed descriptively. RESULTS: Seventeen pairs of conjoined twins were identified. Females predominated, and thoracopagus was the commonest type. Overall mortality was 76.5% (13/17). Ten pairs died during the neonatal period before surgical intervention, while two died from sepsis at one and nine months of age while awaiting separation. Five pairs underwent attempted separation abroad; four were successfully separated, with all surviving children alive at a mean follow-up of 6.5 years, whereas one pair died perioperatively. Thoracopagus twinning and sharing of vital organs, particularly the heart, lungs, and liver, were associated with increased mortality. CONCLUSION: Mortality remains high and is largely attributable to delayed referral, inadequate neonatal referral and transport system, and extensive shared organ involvement. Earlier antenatal diagnosis, coordinated multidisciplinary care, and strengthening local surgical infrastructure, perioperative resources, and intensive care capacity are essential to support complex separation procedures locally and improve outcomes. LEVEL OF EVIDENCE: I.