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Cloacal Malformation in Female Children: Outcome of Initial Management
1Dr. Naima Zamir, Associate Professor, National Institute of Child Health, Karachi, Pakistan.
Insights
Initial management of cloacal malformation in female neonates is critical. This study highlights key surgical approaches and outcomes, emphasizing careful hydrocolpos drainage and stoma placement for better patient recovery.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Surgical Management
Background:
- Cloacal malformation is a rare and complex congenital anomaly in female infants.
- Early diagnosis and appropriate surgical intervention are crucial for patient outcomes.
Purpose of the Study:
- To document the experience of initial surgical management of cloacal malformation in female patients.
- To analyze clinical features, surgical procedures, and outcomes in this cohort.
Main Methods:
- A descriptive retrospective study was conducted from January 2010 to September 2018.
- Data from 60 female patients with cloacal malformation were analyzed, including presentation, clinical features, associated anomalies, surgical interventions, and outcomes.
Main Results:
- Sixty female patients were included, with a median age of four days at presentation.
- Common findings included hydrocolpos (25%), hydronephrosis/hydroureter (23.33%), and associated anomalies (36.66%).
- Surgical management involved bowel diversion (colostomy/ileostomy) in most patients, with 61% experiencing smooth recovery, 30% complications, and 8.33% mortality due to sepsis.
Conclusions:
- Cloacal malformations predominantly present in neonatal life.
- Initial surgical management requires careful attention to hydrocolpos drainage and precise bowel stoma placement.
- Optimizing patient condition pre-operatively and meticulous surgical technique are vital for improving outcomes and reducing complications.
Objective:
To document our experience of initial management of Cloacal malformation in female patients.
Methods:
A descriptive retrospective study was conducted in the Department of Pediatric Surgery of the National Institute of Child Health Karachi from January 2010 to September 2018. Female patients with diagnosis of Cloacal malformation were included in this study. Data regarding the age at presentation, mode of presentation, clinical features, presence of hydrocolpos, and associated anomalies were noted. Surgical procedures performed in these patients and the outcomes were also documented. Data was analyzed on SPSS Version 20.
Results:
Sixty females were included in the study. Age ranged from birth to three years with a median of four days. Patients admitted through emergency were 44 (73.33%) while 16 (26.66%) were admitted through outpatient clinic. Hydrocolpos was found in 15 (25.00%) patients. Five (8.33%) patients had massive abdominal distention and were presented with severe respiratory distress. Among them three had massive hydrocolpos, one patient had pneumoperitoneum secondary to Meckel's perforation and one patient was having massive colonic dilatation. Hydronephrosis and hydroureter were found in 14 (23.33%) patients, while dilated bladder was found in three (5.00%) patients. After optimization of patients, bowel diversion was done as transverse colostomy in 39 (65.00%) patients, high sigmoid colostomy in 17(28.33%) patients while ileostomy was done in three (5.00%) patients. All patients with hydrocolpos had tube vaginostomy. None of the patients required bladder diversion and urinary tract dilatations were gradually subsided in nine patients in the post-operative period. Associated anomalies were found in 22(36.66%) of cases predominantly of sacral origin. Operative complications were found in 18(30.00%) patients, including stoma site in infection in 12(20.00%) patients, vaginal tube dislodgement in two patients, wrong placement of tube in one patient and vaginostomy stenosis in one case. While bowel stoma retraction occurred in four patients, prolapsed was found in three patients. Renal failure occurred in one patient. In total, 37(61.00%) patients had smooth recovery, 18(30.00%) patients had some complications, while Five (8.33%) patients were expired due to sepsis.
Conclusions:
Majority of cloacal malformations present in neonatal life. Initial management is an important step in dealing with these patients. Care must be taken during the abdominal exploration regarding drainage of hydrocolpos and appropriate placement of bowel stoma.
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