FOR THE first seven years of his life Alamjan had a distended stomach. This is not unusual if you live in a remote village in Kazakhstan; his parents, a farmer and his wife, thought he had rickets, his grandmother was too frightened to take him to a doctor.

Then Alamjan started school and other children teased him because he looked pregnant. When the school doctor saw him he insisted that he should go to hospital immediately. There doctors scanned his belly and identified what they thought was a vast cyst. They operated the next day and discovered a large, rounded mass pushing against Alamjan’s stomach and lungs. It was difficult to remove because it was covered in blood vessels connected to Alamjan’s arteries; the operation took 90 minutes.

Alamjan recovered quickly and as he did so the surgeons turned their attention to the object they had removed. With difficulty they cut through the sac that surrounded it. They saw dark hair, arms, fingers and even nails, legs, toes, genitals, a head, an approximation of a face. They had no idea what it was.

Enter Dr Virginia Baldwin, a Vancouver-based paediatric pathologist and a world expert in multiple-pregnancy problems. She suspected that it was a foetus in foetu, a rare condition in which twins are conceived from one egg but the twinning is unequal, and at an early stage of development the incomplete twin is enveloped by the normal one, living off it as a parasite. Alternatively it was possible that it was a cancerous teratoma tumour, which would have implications for Alamjan’s future health. It was important to identify it, and to this end Dr Baldwin travelled to Kazakhstan.

“This was humanoid,” she says. “It had many features of an incomplete twin. To me there was no question that it was a foetus in foetu.”

In the past 200 years only 70 cases of foetus in foetu have been identified but, as a Channel 4 programme explains on Monday, as many as one in eight births is thought to have been conceived as twins, although only 10 per cent deliver as twins. Pregnant women are often unaware that they have lost a twin, and go on to have a healthy baby. Dr Baldwin believes that foetus in foetu is more common than records suggest.

“When twins are conceived there can be competition for resources and only one may survive,” she says. “Depending on the anatomy and physiology of the placenta shared by the twins, a situation may develop which favours one or the other. If there is an imbalance in the blood flow, you have a hazardous situation.

“When you talk to women who are very sensitive to the messages their bodies are giving them, they will say that they knew something was wrong but didn’t know what. There may be no sign. If an abnormal twin developed in the very early stages and didn’t survive, it would often disappear without a trace. That’s why we really don’t know the incidence of this condition.”

In Alamjan’s case there was also potential pyschological trauma to address. His family have told him that he became ill because he ate unwashed fruit — a white lie that Dr Baldwin supports. “For the time being it is an adequate explanation,” she says. “If he washes his fruit in future he may live longer, and this is something he can tell his friends. For him to tell the truth in a country where people don’t have much education would stigmatise him and his family.”

Dr Baldwin was aware, too, of the sense of guilt felt by the family — in particular the mother, who had been told by a local surgeon that she must view the foetus to encourage her to take her children to a doctor if she suspected that they might be ill. Alamjan’s father blamed his wife, believing that she was genetically responsible for the foetus in foetu, an attitude that could lead him to divorce her if he thought her unsuitable to bear healthy children in future.

Part of the reason for Dr Baldwin’s visit was to explain the nature of foetus in foetu, and to reassure Alamjan’s mother that she was not to blame for her son’s condition. She was also able to tell her that Alamjan can expect to lead a normal life and that the problem is not hereditary. But when she arrived at the family’s house the atmosphere was tense.

“Alamjan’s father was very resistant to discussing his son’s operation and the women were uncomfortable discussing it in front of him,” says Dr Baldwin. “This is an accident of nature, we don’t know what causes it, and I told Alamjan’s mother that it was important that she believed me.”

Had Alamjan lived in the West, his condition would have been diagnosed at birth, if not before. Some years ago a scan in America revealed a dark shadow near the kidney of an unborn baby. Three days after the birth, surgeons removed a foetus in foetu. The healthy baby is now a child undamaged by his medical history.

In Britain, Sarah and Razz are expecting their third child in the new year. When Sarah was 18 weeks pregnant with identical twins it was discovered that one acardiac foetus — with neither a heart nor a head — was living parasitically off the other. At Queen Charlotte’s Hospital in London, Professor Nicholas Fisk explained that the strain of pumping blood for two babies could kill the healthy twin. The couple opted for a new keyhole surgery procedure in which Fisk used a laser to sever the connection between the twins. The healthy twin survived the surgery, leaving the acardiac twin floating in the womb. It will be removed when Sarah is delivered by Caesarean section.

Body Shock: The Boy Who Gave Birth To His Twin, Channel 4, Monday, December 8, 9pm