- 8-mo-old patient is referred for evaluation in the Colorectal Center.
- She was born with a cloaca described as “2 cm common channel”.
- She underwent diverting colostomy on day of life 2 but the mucous fistula had closed.
- Patient had a normal sacrum and normal kidneys.
- She did not have tethered cord.
- Pelvic MRI showed one cervix and hemi vagina.
- Bladder was very large.
- On the MRI it looked like the vagina was being pulled upwards.
- On cystoscopy, a 3-cm common channel to the urethra and a second structure were identified.
- Procedure began with posterior sagittal approach. Urethra and vaginas were found.
- Total urogenital mobilization was performed.
- Rectum was not able to be located so an abdominal approach was performed after a total body preparation.
- Rectum was found to be extremely high in the abdomen with only 3 cm of length from the mucous fistula down.
- Blood supply was compromised.
- Proximal stoma was pulled down as the neo-anus.
- Patient has poor prognosis for bowel control.
- In preparation for surgery, the mucous fistula could be reopened so the patient can have all the appropriate studies. A cystoscopy to measure the common channel is another useful exam prior to surgical reconstruction.
- To avoid this situation, the initial colostomy should have been performed at the descending colon instead of low sigmoid.
- A bowel preparation was not performed before surgery as abdominal approach was not expected.
- To prevent contamination intraoperatively, the stoma was packed with gauze.
- While the 5.0 silks were in place, the packing gauze was removed, and a stapler used at the tip of the stoma to prevent contamination.
Patient Case Discussion