Cloacal malformations: lessons learned from 490 cases
Section snippets
Neonatal management
The diagnosis of a cloaca is a clinical one made by identifying a single perineal orifice. The perineum has other important characteristics that help predict the internal anatomy and the final functional prognosis. A “good-looking” perineum consists of a well-formed midline groove and a well-located and clear anal dimple, indicating that the patient has a good sphincter. A “bad-looking” perineum has a single perineal orifice but in addition, a “flat bottom,” with no traces of a sphincter
Definitive reconstruction
Before 1982, the primary surgical treatment of cloacas was not performed with a systematic approach. The related publications were few, with rather poor descriptions of improvised types of operations. Dr Hardy Hendren made significant contributions to the surgical repair of patients born with cloacas.4 He initially referred to these defects as “imperforate anus with urogenital sinus.”5 His main contributions in cloacal management were in secondary operations and in methods to deal with the
Cloacas with a common channel 1 cm or less (n = 43)
In instances of very short common channel cloaca, we recommend a relatively straightforward procedure that we call a posterior sagittal anorectal vaginoplasty. The urethra is left untouched. We separate the rectum from the vagina as in cases of vestibular fistulas, then, rather than separating the vagina from the urinary tract or performing a total urogenital mobilization, we mobilize only the lateral and posterior walls of the vagina, enough to be able to suture the edges of the vagina to the
Postoperative management
In some instances, we repair these malformations and pull the colostomy down for vaginal replacement at the same time. In those cases, because the patient no longer has fecal diversion, they are maintained with nothing by mouth, and receive parenteral nutrition for 7-10 days. Most of the time, however, the colostomy remains intact, and the patient can eat when their postoperative ileus has resolved. They usually stay in the hospital 2-5 days. A Foley catheter remains in place for 2 to 3 weeks.
Conclusions
The newborn management and definitive reconstruction of cloacal malformations requires knowledge of the broad spectrum of defects. With proper treatment, these patients can undergo an excellent anatomical repair and can be clean and dry.
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Surgical management of cloacal malformations: a review of 339 patients
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