Massive haematometrosalpinx in a young girl with cloacal anomalies: Laparoscopic management

D Silva,S Abeygunasekera,J Mathanamohan,W Gankanda,P Randombage

doi:10.4038/sljog.v43i3.7990

Abstract

A cloacal anomaly refers to the collection of defects that occur during fetal development, where the intestinal, urinary and reproductive tracts open into a common cavity. It is imperative to address this condition since despite its fairly low incidence and limited data, it has a very high impact on the patient's quality of life, and therefore mandates further study to effectively manage these patients. This study is regarding a 13-year-old girl diagnosed to have a cloacal anomaly since birth presenting with cyclical abdominal and pelvic pain for 6 months. She had undergone multiple abdominal and pelvic corrective surgeries since birth, leading to a colostomy and Mitrofanoff channel for bowel and bladder control, respectively. Diagnostic imaging revealed bilateral haematosalpinx for which ultrasound guided aspiration followed by subcutaneous administration of GnRH analogues was given as a temporary mode of relief which eventually recurred within 4 months. Following an extensive Multidisciplinary discussion, the team proceeded with the crucial decision of a hysterectomy and bilateral salpingectomy. The surgery itself was challenging due to multiple adhesions, scarring and difficulty in port placement. Following surgery, the patient's quality of life significantly improved allowing her to attend to her activities of daily living and maintain a social life. The need for future appointments to address sexual functions and fertility wishes was explained.

Highlights

What are cloacal anomaliesA cloaca is the persistence of a common cavity into which the intestinal, urinary and reproductive tracts open
Among patients with isolated reproductive malformations, the rate of caesarean section is higher secondary to dystocia and foetal malpresentation; in the population of persistent cloaca, elective caesarean section is recommended to retain the previous reconstructive procedures[3]
The principal objectives of surgical procedures are the establishment of bowel and bladder control, as well as normal sexual function

Summary

Introduction

A cloaca is the persistence of a common cavity into which the intestinal, urinary and reproductive tracts open. We hope to add data to literature regarding the crucial decision of performing a hysterectomy and bilateral salpingectomy of a young patient with persistent cloaca, who has had multiple surgeries in childhood which have resulted in abdominal and severe perineal scarring. This case report will address the best route of surgery, important aspects of laparoscopy such as port placement, and the need for experts to perform such procedures in the background of past multiple surgeries. Future appointments until she reached adulthood were arranged, where creation of a neovagina, future sexual functions and fertility options from her own eggs is to be discussed

Findings

Discussion

Conclusion