8-Month-Old Female Patient Born with a Cloaca Described as a "2-mm Common Channel"

Case Summary

• 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.

Takeaways

• 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.