Female Patient

Cloaca in 4-Year-Old Female Patient with Total Urinary Incontinence (Hendren Patient Case)

  • 4-year-old female patient with total urinary incontinence
  • Cloaca with features seen in clocal exstrophy
  • Ileocolic junction originally joined bladder
  • Distal colon originally joined bladder
  • Distal colon originally ended blindly
  • Two adjoining bladders
  • After an endoscopy 2 weeks later there was reasonable outlet resistance

4-Year-Old Female Patient with Right Colostomy at Birth (Hendren Patient Case)

  • 4-year-old girl sent from abroad in 1986
  • Right colostomy at birth
  • At age 4 months, posterior sagittal operation was attempted, but abandoned after the UGS was inadvertently transected
  • An S.P. tube was placed
  • 8 months later, colostomy was closed and a stricture of the neourethra was opened endoscopically
  • Patient was sullen, unhappy, and uncommunicative when first seen


20-Year-Old Female Patient with Esophageal Atresia with Tracheoesophageal Fistula Repaired at Birth (Hendren Patient Case)

  • 20-year-old female had esophageal atresia with tracheoesophageal fistula (TEF) successfully repaired at birth in a nearby hospital.
  • At age 17 years, we saw her for a “cold nodule” of the left thyroid.
  • Hemithyroidectomy was performed for what proved to be a follicular adenoma
  • Barium swallow at that age showed dysmotility of the esophagus commonly seen following repair of esophageal atresia, but not gastroesophageal reflux or other abnormality.
  • She now had a history of dysphagia for 3 mo when swallowing solid foods, and a weight loss of 4.5 kg (10 pounds).
  • Barium swallow showed an intraluminal mass at the esophagogastric junction.

Fig. 1. Pre-Operative Barium Swallow (Select Image for High-quality Version). This demonstrates an irregular intraluminal lesion at and above the gastroesophageal junction.

Fig. 2. Endoscopic View of Upper End of Esophagogastric Adenocarcinoma (Select Image for High-quality Version). Esophagoscopy showed an obvious carcinoma of the esophagus, a well differentiated adenocarcinoma histologically.

Treatment Strategy

  • Using a left thoracoabdominal approach, tumor was removed and all lymph nodes in the specimen were negative microscopically for tumor.
  • Patient had an uneventful recovery from the esophagogastrectomy in November 1987.

Fig. 3. Pre-Operative Anatomy (Select Image for High-quality Version). Diagram shows the extent of tumor and of resection to be performed using a thoracoabdominal exposure. 

Fig. 4. Post-Operative Barium Swallow (Select Image for High-quality Version). This shows colon interposition from mid esophagus to remaining stomach.

Fig. 5. Post-Operative Anatomy (Select Image for High-quality Version). Anatomy after tumor resection, and restoring gastrointestinal continuity with segment of transverse colon on left gastric pedicle. Note pyloroplasty to enhance gastric emptying.

Follow Up

  • In 1992, 15 years later at age 26 years we performed a left thyroid gland total removal.
  • Histology showed benign modular goiter.
  • Patient last seen in 1994 and she was well.