Female Patient

• Newborn female patient
• Esophageal atresia repaired as neonate
• Had cloaca
• Loop sigmoid colostomy was done
• Referred at age 5½ years for cloacal repair
• Chronic spillover of stool from loop colostomy, filling vagina and bladder with reflux, severe renal scaring

• 18-month-old female patient referred with total urinary incontinence
• Prior colostomy at birth
• Soave type rectal pullthrough at 1 year, and later colostomy closure.

• 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 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

• 15-month-old baby girl with a cloaca and a very large intrapelvic sacrococcygeal teratoma
• Prior suprapubic cystostomy and sigmoid colostomy at birth

• 20-year-old female totally incontinent of urine and stool when referred in 1979
• Prior operations included colostomy, colon pullthrough, right nephrectomy, and a flap to enlarge the UGS opening
• She was in diapers

• Neonate in 1964 with very primitive anatomy with features usual in babies with cloacal exstrophy

• Ostensibly a “usual” cloaca with normal-appearing introitus and imperforate anus
• However, pelvic contents were highly abnormal

• 2-year-old female with two vaginas on opposite sides of the urogenital sinus and required only a transverse colostomy at birth in Europe
• She required colon to extend vagina to perineum

• 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.