A cloacal malformation is defined as a confluence of the rectum, vagina, and urethra into a single usual channel. This defect is one of the most formidable technical challenges in pediatric surgery.
In cloacal malformation, there is a single drainage channel in the perineum instead of a separate rectum, urethra, and vagina. preliminarily, an anorectal malformation (absent anus) might be suspected. The external genitalia might be small and the clitoris oversized, which might lead to an initial diagnosis of a disorder of sex development. On closer examination, a single opening in the perineum becomes apparent.
The cloacal malformation is associated with other malformations like:
1) Oesophageal atresia and tracheoesophageal fistula (OA/TOF) where the bottom end of the esophagus is not developed or is joined to the trachea (windpipe).
2) Structural heart problems.
3) Structural problems with the lower spine.
4) Kidney problems like hydronephrosis, vesicoureteric reflux, duplex kidney or ectopic ureters.
The cloacal malformation may be suspected before birth (prenatally) on routine ultrasound, which can show bilateral (both sides) hydronephrosis that’s, the kidneys are swollen with urine (pee) because they can’t drain properly. The bladder might not be very clear on the scan and there can also be a cyst-like swelling in the abdomen. If the cloacal malformation is suspected, repeat ultrasound scans will be carried out throughout pregnancy to monitor the problem.
Soon after birth, cloacal malformation could be suspected if the meconium (the dark feces passed in the initial few days of life) isn’t passed or it comes from a different place. The physical examination will ensure the diagnosis. Imaging scans, like ultrasound and echocardiogram, will be used to identify any associated issues.
Instantly after birth, babies will require to be stabilized if any associated issues are life-threatening. this could involve a stay in intensive care with breathing support and/or transfer to a specialist center for treatment. as an example, babies with oesophageal atresia will be transferred to GOSH for an operation before long after birth to enable them to feed safely. they’ll ordinarily have an intravenous (into a vein or IV) infusion of fluids as they will not be ready to feed at first. they’ll also have antibiotics intravenously.
A nasogastric (NG) tube will be passed down the throat into the stomach to drain off any fluid and air to create the baby more comfortable. A urethral catheter will be passed into the common channel to drain off fluid to reduce any swelling and potential harm to the kidneys. Rarely, a catheter may require to be inserted through the abdominal wall into the bladder if insertion into the common channel isn’t successful.
When the baby is stable, surgery to construct a stoma (artificial opening to the bowel) will be carried out so that feces may be passed safely and feeds by mouth (breast or bottle feeding) can be introduced. The stoma will also enable the bowel to deflate or shrink back to general size as it will vent off excess air. throughout the operation to create the stoma, the surgeons might examine the cloacal malformation more closely using a cystoscope a tube containing a micro camera and a light.
Children could ordinarily be discharged home when the stoma has settled ordinarily after a stay of 5 to ten days in the hospital. Regular check-ups will be required until the next stage of treatment and all kids will continue to have antibiotics to stop infection affecting the kidneys. Regular blood tests will be continued to verify kidney function. If pee isn’t draining freely from the bladder, catheterization either through the common channel or through the abdominal wall into the bladder will be required.
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