Lakshmi Tatma is an Indian girl born in 2005 in a village in

Araria district Araria district is one of the thirty-eight districts of Bihar state, India. Araria district is a part of Purnia division. The district occupies an area of . Araria town is the administrative headquarters of this district. Etymology During the B ...

Bihar Bihar (; ) is a state in eastern India. It is the 2nd largest state by population in 2019, 12th largest by area of , and 14th largest by GDP in 2021. Bihar borders Uttar Pradesh to its west, Nepal to the north, the northern part of West ...

, with "4 arms and 4 legs." She was actually one of a pair of ischiopagus

conjoined twins Conjoined twins – sometimes popularly referred to as Siamese twins – are twins joined '' in utero''. A very rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence ...

, one of which was headless because its head had atrophied and chest had not fully developed in the womb, causing the appearance of one child with four arms and four legs. She has undergone surgery to remove these extra limbs.

Background

Lakshmi's father, Shambhu, and mother, Poonam, were day laborers who earned less than 40

rupees Rupee is the common name for the currencies of India, Mauritius, Nepal, Pakistan, Seychelles, and Sri Lanka, and of former currencies of Afghanistan, Bahrain, Kuwait, Oman, the United Arab Emirates (as the Gulf rupee), British East Africa, ...

per day and were unable to afford a separation surgery for their daughter. The daughter was named after

Lakshmi Lakshmi (; , sometimes spelled Laxmi, ), also known as Shri (, ), is one of the principal goddesses in Hinduism. She is the goddess of wealth, fortune, power, beauty, fertility and prosperity, and associated with ''Maya'' ("Illusion"). Alo ...

, the Hindu goddess of wealth (who is depicted as four-armed). The girl was sometimes an object of worship as an incarnation of the goddess; by the age of two, she was known all over India. At one point, a

circus A circus is a company of performers who put on diverse entertainment shows that may include clowns, acrobats, trained animals, trapeze acts, musicians, dancers, hoopers, tightrope walkers, jugglers, magicians, ventriloquists, and uni ...

offered the couple money to buy Lakshmi as a

sideshow In North America, a sideshow is an extra, secondary production associated with a circus, carnival, fair, or other such attraction. Types There are four main types of classic sideshow attractions: *The Ten-in-One offers a program of ten s ...

, which forced the family into hiding. At the time of being found by Sharan Patil, the girl was suffering from an infected

pressure ulcer Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combi ...

at the neck end of the

parasitic twin A parasitic twin, also known as an asymmetrical or unequal conjoined twin, is the result of the processes that also produce vanishing twins and conjoined twins, and may represent a continuum between the two. Parasitic twins occur when a twin emb ...

and continuous

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

Surgery

Lakshmi was the subject of a surgery carried out by Sharan Patil and 30 other physicians which included Chief

anesthetist Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...

Yohannan John Yohannan is a Syriac name, from the Hebrew name Yohanan, equivalent to English John, French Jehan, Spanish Juan, and German Johannes. It may refer to: *Yohannan the Leper, Yohannan Garba ("the Leper"), originally metropolitan of Nisibis, was ant ...

at Sparsh Hospital in

Bangalore Bangalore (), officially Bengaluru (), is the capital and largest city of the Indian state of Karnataka. It has a population of more than and a metropolitan population of around , making it the third most populous city and fifth most ...

Karnataka Karnataka (; ISO: , , also known as Karunāḍu) is a state in the southwestern region of India. It was formed on 1 November 1956, with the passage of the States Reorganisation Act. Originally known as Mysore State , it was renamed ''Kar ...

. The twins' two pelvises formed a single combined ring. Each twin had one working

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...

. Lakshmi had a second kidney which was

necrotic Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dig ...

. The autosite's (Lakshmi herself) feet were affected by

clubfoot Clubfoot is a birth defect where one or both feet are rotated inward and downward. Congenital clubfoot is the most common congenital malformation of the foot with an incidence of 1 per 1000 births. In approximately 50% of cases, clubfoot aff ...

. Her

abdominal aorta In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta (of the thorax). Structure The abdominal aorta begins at the level of the diaphragm ...

gave off iliac branches to the autosite's legs and continued as a main trunk artery which gave off iliac branches to the parasite's legs and continued, and finally forked into the parasite's

subclavian arteries In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplie ...

. The parasitic twin's spine and abdomen merged with Lakshmi's body. The twins' backbones were joined end-to-end and nerves were entangled. Lakshmi could not crawl normally or walk, but she could drag herself around somewhat. Doctors surmised early on that without the operation, she would not be able to live into her teens. The surgery began on Tuesday, 6 November 2007, at 7:00a.m. IST (01:30 UTC), and was planned to last 40hours at the most. An estimated cost of over

US$ The United States dollar (symbol: $; code: USD; also abbreviated US$ or U.S. Dollar, to distinguish it from other dollar-denominated currencies; referred to as the dollar, U.S. dollar, American dollar, or colloquially buck) is the official ...

625,000 was paid entirely by the hospital's charitable wing, the Sparsh Foundation. A team of more than 30 surgeons worked in shifts. The surgery lasted for 27 hours, and doctors gave Lakshmi a 75–80% chance of survival during the surgery. The steps of the operation were: # (8 hours): Abdominal operation: remove the parasite's abdominal organs. # Remove the autosite's necrotic kidney and replace it with the parasite's kidney. Tie off the blood vessels that supplied the parasite. # Move the

reproductive system The reproductive system of an organism, also known as the genital system, is the biological system made up of all the anatomical organs involved in sexual reproduction. Many non-living substances such as fluids, hormones, and pheromones are al ...

and the

urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

into the autosite. # (6 to 8 hours) Amputate the parasite's legs at the hip joints: this caused heavy bleeding. Cut the joined backbone: the nerves around the joint were found to be extremely chaotic, and care had to be taken to avoid causing

paralysis Paralysis (also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 5 ...

. # Separation, at 12.30p.m. on 7 November 2007. The combined pelvic ring was divided through or near the parasite's hip joints and not at the pubic symphyses. The remaining incomplete pelvic ring was cut and bent to make the ends meet, and not left as an open part-circle. #

External fixation External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...

to hold the parts of the pelvis in place. This caused the pelvis to close in three weeks to the normal position. # (4 hours):

Suturing A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread ...

. Operation completed at 10:00a.m. on 7 November 2007. Within a week of the surgery, doctors held a

press conference A press conference or news conference is a media event in which notable individuals or organizations invite journalists to hear them speak and ask questions. Press conferences are often held by politicians, corporations, non-governmental or ...

showing Lakshmi being carried by her father. Her feet were still bandaged. She was in the hospital for a month after the operation. Afterwards, she and her family moved to Sucheta Kriplani Shiksha Niketan in

Jodhpur Jodhpur (; ) is the second-largest city in the Indian state of Rajasthan and officially the second metropolitan city of the state. It was formerly the seat of the princely state of Jodhpur State. Jodhpur was historically the capital of the ...

Rajasthan Rajasthan (; lit. 'Land of Kings') is a state in northern India. It covers or 10.4 per cent of India's total geographical area. It is the largest Indian state by area and the seventh largest by population. It is on India's northwestern s ...

, where Lakshmi and her brother joined a school for disabled children and her father got a job at the school's farm. As of February 2008, a later operation was planned to bring her legs closer together. Another operation may be needed to rebuild her

pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the l ...

muscles. A television program in 2010'' Bodyshock'

10p.m. Thursday 28 January 2010, on

Channel 4 Channel 4 is a British free-to-air public broadcast television network operated by the state-owned enterprise, state-owned Channel Four Television Corporation. It began its transmission on 2 November 1982 and was established to provide a four ...

. showed her recovering well. It was found that cutting the conjoined vertebral column in the separation operation had not caused

. She was operated on for clubfoot. X-rays showed that extra bone between the

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubi ...

(parts of the parasitic twin's

ischium The ischium () form ...

and pubis bones) had been absorbed or was not

ossified Ossification (also called osteogenesis or bone mineralization) in bone remodeling is the process of laying down new bone material by cells named osteoblasts. It is synonymous with bone tissue formation. There are two processes resulting in t ...

. Slight

scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...

was found but would have to be corrected by a minor operation; her mother was unwilling for her to have to wear a spinal brace throughout childhood.

References

External links

Spines of 2-year-old Lakshmi separated: Doctors

Times of India ''The Times of India'', also known by its abbreviation ''TOI'', is an Indian English-language daily newspaper and digital news media owned and managed by The Times Group. It is the third-largest newspaper in India by circulation and largest ...

2007-11-06
Many-limbed India girl in surgery

BBC News BBC News is an operational business division of the British Broadcasting Corporation (BBC) responsible for the gathering and broadcasting of news and current affairs in the UK and around the world. The department is the world's largest broad ...

2007-11-06
Surgery for girl with eight limbs is going smoothly doctors say
(video) CNN 2007-11-06
Surgery On Multi-Limbed Girl A Success
(with video and photographs) CBS News 2007-11-07
Girl Born With 4 Arms, 4 Legs Has Successful Surgery

ABC News ABC News is the journalism, news division of the American broadcast network American Broadcasting Company, ABC. Its flagship program is the daily evening newscast ''ABC World News Tonight, ABC World News Tonight with David Muir''; other progra ...

2007-11-07
Girl separation surgery a success
(with video)

2007-11-07 {{DEFAULTSORT:Tatma, Lakshmi 2005 births Living people People with parasitic twins People from Araria Indian children Indian twins 2005 in India 2007 in India Medicine in India Surgical procedures and techniques