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

Director, International Center for Colorectal and Urogenital Care, Children’s Hospital Colorado, Aurora, CO

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.


  • 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

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