Common cloaca: An uncommon entity posing diagnostic and management challenges: Our experience with nine cases

Area of Science:

• Pediatric Surgery
• Congenital Anomalies
• Urology

Background:

• Cloacal anomalies represent the most severe anorectal malformations (ARMs).
• These complex conditions necessitate precise surgical approaches adapted to individual variants.
• This study details the management experience of nine pediatric cases.

Purpose of the Study:

• To present the surgical experience and outcomes for patients with cloacal anomalies.
• To evaluate the effectiveness of surgical interventions in achieving urinary and bowel continence.

Main Methods:

• Retrospective review of nine cases of cloaca managed at a tertiary care center (2015-2019).
• Analysis of associated anomalies, surgical procedures (rectal separation with total urogenital mobilization), and common channel length.
• Evaluation of postoperative complications, follow-up duration, and continence outcomes.

Main Results:

• Associated anomalies were present in 44% of cases.
• Definitive surgery occurred at a mean age of 15.2 months.
• Post-surgery, 63% achieved spontaneous voiding, while 37% required clean intermittent catheterization.
• Bowel management challenges included soiling (66%) and constipation (44%), with 77% requiring daily enemas.

Conclusions:

• Cloacal anomalies are rare and intricate ARMs.
• Effective urinary and bowel continence is achievable despite the complexity of these malformations.
• Tailored surgical strategies are crucial for optimal patient outcomes.