Dr Heiter, kidnapping a truck driver by the side of a road. Later, two American tourists, Lindsay and Jenny, arrive at Heiter's house as they search for help after puncturing their car tire. Heiter drugs the women and they awake along with the kidnapped trucker in a makeshift hospital ward in the cellar. Heiter informs the trucker that he is "not a match" and kills him. When the women next wake, they are joined by a new captive, Japanese tourist Katsuro.
The doctor explains that he is a world renowned expert at separating conjoined twins, but dreams of creating new beings that share a single digestive system by joining separate individuals via their mouths and anuses.