eMedicine Specialties > Pediatrics: Surgery > General Surgery

Cloacal Malformations: Workup

Author: Marc A Levitt, MD, Assistant Professor of Surgery and Pediatrics, University of Cincinnati; Associate Director, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center
Coauthor(s): Alberto Pena, MD, Consulting Surgeon, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center
Contributor Information and Disclosures

Updated: Jul 10, 2007

Workup

Laboratory Studies

  • Patients with an untreated obstructive uropathy may have acidosis.

Imaging Studies

  • Newborn period

    • The radiologic evaluation of a newborn with persistent cloaca includes abdominal ultrasonography to evaluate for urologic anomalies and a distended vagina (hydrocolpos).
    • Plain radiography of the spine can show spinal anomalies, such as spina bifida and spinal hemivertebrae.
    • Plain radiography of the sacrum in the anterior-posterior and lateral projections can reveal sacral anomalies, such as a hemisacrum and sacral hemivertebrae. Also, the degree of sacral hypodevelopment can be assessed, and a sacral ratio can be calculated by measuring the distances between key bony structures (see Image 15).
    • Spinal ultrasonography in patients younger than 3 months can be performed to evaluate for evidence of a tethered spinal cord and other spinal anomalies. In patients older than 3 months, the radiologist cannot visualize this area with ultrasonography because ossification of the sacrum has occurred, closing the window for ultrasonographic visualization.
  • After the newborn period

    • After the colostomy has been created, outpatient radiologic evaluation of the cloaca involves injection of hydrosoluble contrast in all possible orifices in order to determine the anatomy. Injection of the perineal orifice, distal colostomy, the cystostomy tube, and the vaginostomy tube, if present,  may all contribute to defining the anatomy. A colostomy with a mucous fistula is essential because the anatomy can be radiologically investigated through the distal stoma.
    • MRI is necessary in infants older than 3 months to evaluate for the presence of tethered cord and other spinal anomalies if ultrasonography was not performed in the neonatal period.

Other Tests

  • Cystoscopy and vaginoscopy are essential components for evaluation of the patient with persistent cloaca. Many surgeons choose to perform endoscopy before the main repair so that the anatomy can be defined and the complex surgery can be planned. With the information obtained from the endoscopy, the surgeon can usually predict whether a laparotomy will be required in combination with the perineal approach. Insight into the extent of vaginal reconstruction needed can also be ascertained. The anatomic questions that can be ascertained include the following:

    • The length of the common channel
    • The presence of a vagina
    • The presence of hemivagina
    • The presence of a cervix (or cervices)

More on Cloacal Malformations

Overview: Cloacal Malformations
Workup: Cloacal Malformations
Treatment: Cloacal Malformations
Follow-up: Cloacal Malformations
Multimedia: Cloacal Malformations
References
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References

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Further Reading

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Keywords

cloacal malformations, anorectal malformations, cloaca, cloacal anomalies, persistent cloaca, confluence of the rectum, confluence of the urethra, confluence of the vagina, urogenital sinus, posterior sagittal approach, posterior sagittal anorectovaginourethroplasty, PSARVUP, urinary continence, fecal continence, rectovaginal fistula, hydrocolpos, imperforate anus, vaginal scarring, cloacal exstrophy, midline intestinal plate, omphalocele, vesicostomy, genitourinary defects, rectovesical fistula, rectovestibular fistula, rectobulbar fistula, rectoperineal fistula, tethered cord, tethered spinal cord, presacral mass, dermoids, teratomas, anterior meningoceles, Currarino triad, hemisacrum, Mitrofanoff procedure, acidosis, spina bifida, spinal hemivertebrae

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Contributor Information and Disclosures

Author

Marc A Levitt, MD, Assistant Professor of Surgery and Pediatrics, University of Cincinnati; Associate Director, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center
Marc A Levitt, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Alberto Pena, MD, Consulting Surgeon, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Aviva L Katz, MD, Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh
Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Gail E Besner, MD, Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine and Public Health; Director, Pediatric Surgical Research, Department of Surgery, Children's Hospital
Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Pediatric Oncology Group, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD, Professor of Surgery, Feinberg School of Medicine, Northwestern University; Interim Head, Division of Pediatric Surgery, Department of Surgery, Children's Memorial Hospital of Chicago
Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

 
 
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