Abstract
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.
Highlights
Cloacal malformation is rare but one of the most complex and challenging varieties of anorectal malformation encountered in the pediatric population
We are sharing our experience of the clinical presentation, initial management and its outcome in patients with Cloacal malformation admitted in our institute
Female patients with imperforate anus having single perineal opening in the vestibule with the clinical diagnosis of cloacal malformation were included in the study and underwent initial surgical procedure according to their presentation
Summary
Cloacal malformation is rare but one of the most complex and challenging varieties of anorectal malformation encountered in the pediatric population. Malformation.[1,2] By definition, it is a common caudal channel into which urethra, vagina, and rectum terminate and open at the anterior part of the perineum as a single opening.[3] Embryologically, all three channels fail to develop separately.[4,5] Almost all the cases are of female gender, whereas male cases are very rarely documented.[6] According to Alberto Pena, many of the cases diagnosed as the rectovaginal fistulas, are cloaca, which are misdiagnosed and mismanaged.[7] The complexity increases when anomaly is associated with hydrocolpos, so is its management.
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