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. The Nepali border is abo ...

Bihar Bihar ( ) is a states and union territories of India, state in Eastern India. It is the list of states and union territories of India by population, second largest state by population, the List of states and union territories of India by are ...

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

conjoined twins Conjoined twins, popularly referred to as Siamese twins, are twins joined '' in utero''. It is a very rare phenomenon, estimated to occur in anywhere between one in 50,000 births to one in 200,000 births, with a somewhat higher incidence in south ...

, 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 labourers who earned less than 40 rupees 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, revered as the goddess of wealth, fortune, prosperity, beauty, fertility, sovereignty, and abundance. She along with Parvat ...

, the

Hindu Hindus (; ; also known as Sanātanīs) are people who religiously adhere to Hinduism, also known by its endonym Sanātana Dharma. Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pp. 35–37 Historically, the term has also be ...

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 unicy ...

offered the couple money to buy Lakshmi as a

sideshow In North America, a sideshow is an extra, secondary production associated with a circus, traveling carnival, carnival, fair, or other such attraction. They historically featured human oddity exhibits (so-called “Freak show, freak shows”), pr ...

, which forced the family into hiding. At the time of being found by Sharan Patil, she had an infected

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

at the neck end of the

parasitic twin A parasitic twin, also known as an asymmetrical twin or unequal conjoined twin, occurs when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other. ...

and continuous

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

Surgery

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

anaesthetist 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, a ...

Yohannan John at Sparsh Hospital in

Bangalore Bengaluru, also known as Bangalore (List of renamed places in India#Karnataka, its official name until 1 November 2014), is the Capital city, capital and largest city of the southern States and union territories of India, Indian state of Kar ...

Karnataka Karnataka ( ) is a States and union territories of India, state in the southwestern region of India. It was Unification of Karnataka, formed as Mysore State on 1 November 1956, with the passage of the States Reorganisation Act, 1956, States Re ...

. The twins' two

pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...

es formed a single combined ring. Each twin had one working

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

. 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. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who is ...

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

clubfoot Clubfoot is a congenital or acquired 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 ca ...

. 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. 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 Coordinated Universal Time (UTC) is the primary time standard globally used to regulate clocks and time. It establishes a reference for the current time, forming the basis for civil time and time zones. UTC facilitates international communica ...

), and was planned to last 40hours at the most. An estimated cost of over $625,000 American dollars 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 Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

. 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 bladder () is a hollow organ in humans and other vertebrates that stores urine from the Kidney (vertebrates), kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the ...

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 (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

. # Separation, at 12.30a.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 Kirschner wire, Kirschner pins and wires are inserted and affixed into bone and then exit the body to be attached to an external apparatus composed of rings and threaded rods — the Ilizarov app ...

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 Tissue (biology), body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a Sewing needle, needle w ...

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

press conference A press conference, also called news conference or press briefing, is a media event in which notable individuals or organizations invite journalism, journalists to hear them speak and ask questions. Press conferences are often held by politicia ...

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 of the north-western Indian state of Rajasthan, after its capital Jaipur. As of 2023, the city has a population of 1.83 million. It serves as the administrative headquarters of the Jodhpur district and ...

Rajasthan Rajasthan (; Literal translation, lit. 'Land of Kings') is a States and union territories of India, state in northwestern India. It covers or 10.4 per cent of India's total geographical area. It is the List of states and union territories of ...

, 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 an anatomical location in the human body which has an important role in urinary and anal continence, sexual function, and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and ...

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 channel owned and operated by Channel Four Television Corporation. It is state-owned enterprise, publicly owned but, unlike the BBC, it receives no public funding and is funded en ...

. 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 (: symphyses) 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 attache ...

(parts of the parasitic twin's

ischium The ischium (; : is ...

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 (: scolioses) is a condition in which a person's Vertebral column, spine has an irregular curve in the coronal plane. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others ...

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'' (''TOI'') is an Indian English-language daily newspaper and digital news media owned and managed by the Times Group. It is the List of newspapers in India by circulation, third-largest newspaper in India by circulation an ...

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 Cable News Network (CNN) is a multinational news organization operating, most notably, a website and a TV channel headquartered in Atlanta. Founded in 1980 by American media proprietor Ted Turner and Reese Schonfeld as a 24-hour cable ne ...

2007-11-06
Surgery On Multi-Limbed Girl A Success
(with video and photographs)

CBS News CBS News is the news division of the American television and radio broadcaster CBS. It is headquartered in New York City. CBS News television programs include ''CBS Evening News'', ''CBS Mornings'', news magazine programs ''CBS News Sunday Morn ...

2007-11-07
Girl Born With 4 Arms, 4 Legs Has Successful Surgery

ABC News ABC News most commonly refers to: * ABC News (Australia), a national news service of the Australian Broadcasting Corporation * ABC News (United States), a news-gathering and broadcasting division of the American Broadcasting Company ABC News may a ...

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