- 6½-year-old female patient was referred in 1976 for extensive secondary surgery of her cloacal malformation
- Thirteen prior operations included:
- Colostomy at birth
- Bilateral loop ureterostomies
- Attempted vaginal pullthrough
- Opening of the urogenital sinus
- Suprapubic cystostomy
- Closure of the bladder neck
- Patient at 42 years described her overall status as great!
- By age 7 years, she had urinary control but used daily enemas to evacuate the colon
- Urine and bowel control were complete at age 9
- At age 15 years, a right buttocks flap was inserted into the vagina to enlarge its caliber
- Flap base was replaced 6 months later
- Rectum was moved back a little to position it better in the sphincter muscles
- At age 18 years, a right lower quadrant mass necessitated through the abdominal wall
- The tube and ovary were removed
- Right uterus was later removed elsewhere.
- This patient illustrates responsibility to plan wisely and thoroughly in dealing with complex malformations so that the patient can live a life of good quality
- In this baby, the original surgery had been ill conceived
- When she was 6, plans were made for permanent urinary diversion, until the family read in a lay magazine that undiversion was a possible course of action
- 20-hour operation she endured made that possible.
- Rare cases like cloacas should be triaged to a limited number of loci where experience can be maximized
Publications & Educational Resources
Urogenital Sinus and Anorectal Malformation: Experience with 22 Cases