This is a case study of malformed conjoined twins in a spontaneous triplet pregnancy. A 20-year-old primigravida spontaneously delivered at 22 weeks gestation a normal 425-gram male newborn followed by a delivery of a 525 grams pygopagus conjoined male twins. One twin had omphalocele, missing ears, cleft palate and dysmorphic figures while the other had imperforated anus and dysmorphic figures. The Apgar scores were 2/0. The placenta was monochorionic/diamniotic with single umbilical artery supplying both conjoined twins. Conjoined twin in a triplet pregnancy may be diagnosed by ultrasound as early as the first trimester. Failure in diagnosis of the condition resulted in early delivery of three premature infants. All three infants died after delivery.