Correlation between Common Channel Length and Urethral Length in Cloacal Malformations

Introduction This research aimed to study the relationship between common channel length and urethral length in cloaca patients by different diagnostic modalities and the ability of common channel length to predict the urethral length. Materials and Methods The study was conducted on 30 cases of cloaca managed at Alexandria University Children Hospital and Cairo University Children Hospital from August 2018 to December 2019. Preoperative assessment included cystovaginoscopy and magnetic resonance imaging (MRI) studies with a recording of common channel length and urethral length by each modality. Results There is substantial similarity between MRI and cystoscopy in measuring common channel length; 11 patients had common channel length 1 to 3 cm by cystoscopy. It is the same number by MRI measurement. Nineteen patients had common channel length 3 to 5 cm by cystoscopy and MRI. In total, 16 had urethral length <1.5 cm by MRI, while 14 patients with urethral length <1.5 cm by cystoscopy. However, there is a moderate negative correlation by MRI between common channel length and urethral length, while by cystovaginoscope, there is no significant correlation between common channel length and urethral length. Conclusion Applying MRI or cystoscopy in the preoperative assessment of cloaca cases is equivalent to measuring common channel length, not measuring urethral length. Besides that, the common channel length cannot predict the urethral length.

Prenatale echografische diagnose van een cloacale malformatie

Prenatal ultrasound diagnosis of a cloacal malformation Cloacal malformations are a spectrum of rare congenital disorders caused by the arrest of the cloacal division during different stages in early embryogenesis. They necessitate critical intervention at birth, posing important surgical challenges. The majority unfortunately remains undetected during prenatal screening. Knowledge about sonographic red flags, however, may improve antenatal detection and therefore postnatal outcome as a result of a timely referral to multidisciplinary tertiary centers. A 29-year-old patient presents at the hospital due to decreased fetal movements in the third trimester of pregnancy. The ultrasound reveals an anechoic bilobed cystic mass with a thick midline septum within the pelvis of a female fetus. The diagnosis of a cloacal anomaly with associated duplicated vaginas and uteri is made. Severe accumulation of urine lies at the base of bilateral hydrocolpos, peritoneal ascites and a urinary tract obstruction with an adverse influence on both pulmonary and renal development. The baby is prematurely delivered by an emergency caesarean section. Her condition is poor, requiring immediate respiratory resuscitation. An explorative laparotomy on the following day confirms the diagnosis. The first steps towards anatomical correction are taken. It may be concluded that the triad of bilateral hydronephrosis, a pelvic cystic mass and an absent normal bladder within a female fetus should always raise suspicion of a cloaca.

Cloacal Malformation in Female Children: Outcome of Initial Management

Objective: To document our experience of initial management of Cloacal malformation in female patients. Methods: A descriptive retrospective study was conducted in the Department of Pediatric Surgery of the National Institute of Child Health Karachi from January 2010 to September 2018. Female patients with diagnosis of Cloacal malformation were included in this study. Data regarding the age at presentation, mode of presentation, clinical features, presence of hydrocolpos, and associated anomalies were noted. Surgical procedures performed in these patients and the outcomes were also documented. Data was analyzed on SPSS Version 20. Results: Sixty females were included in the study. Age ranged from birth to three years with a median of four days. Patients admitted through emergency were 44 (73.33%) while 16 (26.66%) were admitted through outpatient clinic. Hydrocolpos was found in 15 (25.00%) patients. Five (8.33%) patients had massive abdominal distention and were presented with severe respiratory distress. Among them three had massive hydrocolpos, one patient had pneumoperitoneum secondary to Meckel’s perforation and one patient was having massive colonic dilatation. Hydronephrosis and hydroureter were found in 14 (23.33%) patients, while dilated bladder was found in three (5.00%) patients. After optimization of patients, bowel diversion was done as transverse colostomy in 39 (65.00%) patients, high sigmoid colostomy in 17(28.33%) patients while ileostomy was done in three (5.00%) patients. All patients with hydrocolpos had tube vaginostomy. None of the patients required bladder diversion and urinary tract dilatations were gradually subsided in nine patients in the post-operative period. Associated anomalies were found in 22(36.66%) of cases predominantly of sacral origin. Operative complications were found in 18(30.00%) patients, including stoma site in infection in 12(20.00%) patients, vaginal tube dislodgement in two patients, wrong placement of tube in one patient and vaginostomy stenosis in one case. While bowel stoma retraction occurred in four patients, prolapsed was found in three patients. Renal failure occurred in one patient. In total, 37(61.00%) patients had smooth recovery, 18(30.00%) patients had some complications, while Five (8.33%) patients were expired due to sepsis. Conclusions: Majority of cloacal malformations present in neonatal life. Initial management is an important step in dealing with these patients. Care must be taken during the abdominal exploration regarding drainage of hydrocolpos and appropriate placement of bowel stoma. doi: https://doi.org/10.12669/pjms.36.2.1095 How to cite this:Zamir N. Cloacal Malformation in Female Children: Outcome of Initial Management. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1095 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Complex Cloacal Malformations: The Application and Importance of Cloacagrams

Cloaca is a rare complex anorectal malformation in female patients where the urinary, gynecologic, and gastrointestinal tracts empty through a single pathway, known as the common channel. Previously, cloacas were measured through endoscopic evaluation alone. In recent years, radiographic imaging of the cloaca with a 3D cloacagram, has been a valuable tool for the characterization of the specific anatomical variables in each cloaca, and provides additional information that is beneficial for the preoperative surgical planning. This article reviews the embryology of cloaca, as well as the classification, noninvasive imaging, cloacagram protocol, and surgical intervention.