This is a case report on symmetrical ischiopagus tetrapus. We made exact preoperative examinations of the topographic anatomical relationships before performing the separation at the age of ten months. Both twins survived the operation without complication. A second procedure to correct the misformed pelvices of both children was successfully performed. The twins have been released from the hospital. One child, who can walk, lives with his parents. The second child has a perinatal brain defect, and as such is cared for in a nursing home.