Cloacal malformations: embryology, anatomy and principles of management

The cloacal anomaly is characterised by the persistence of a common channel draining the urinary, genital and alimentary tracts via a single orifice. It results from abnormal compartmentalisation of features that are normal in the primitive female embryo. Abnormal embryology and cloacal anatomy are described in detail. Cloacal abnormalities are usually diagnosed promptly in the neonatal period. Management can be divided into three phases: (1) investigating and defining the anatomy, (2) neonatal intervention with relief of obstruction and (3) definitive surgical reconstruction. Successful management of the child with a cloacal abnormality remains one of the greatest challenges to the pediatric surgeon.