6½-Year-Old Female Patient Referred for Extensive Secondary Surgery of Her Cloacal Malformation (Hendren Patient Case)

Case Overview: 
  • 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
Follow Up: 
  • 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


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