Re: Spinal Ultrasound in Patients with Anorectal Malformations: Is This the End of an Era?

Abstract

Editorial Comment: These authors, who have tremendous experience with cloaca and cloacal exstrophy, report on 19 children who underwent a higher diversion (as opposed to an end colostomy) and who were converted from a more proximal ileostomy that previously left the distal colon defunctionalized to an end colostomy with complete separation of the colonic segment from the bladder. Of 66 patients in their series of cloacal exstrophy 9 who had previously undergone ileostomy or proximal colostomy were rediverted with refunctionalization of the distal ileum or colon. Of the 19 children 10 remained with the colostomy awaiting further reconstruction and possible pull-through, while 6 underwent pull-through after responding to a bowel management program and 2 will have a permanent stoma. One patient died. Following the “rescue operation” a number of patients had resolution of acidosis and improvement in weight gain. While most teams understand the importance of complete separation of the ileum and colon from the urinary tract in the management of cloacal exstrophy, this article provides additional evidence of the importance of the initial management.