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Prenatal Rupture of Hydrocolpos in a Cloacal Malformation
Su Yeon Lee1, Jordan E Jackson2, Abd-Elrahman Said Hassan3
1Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA, suyle@ucdavis.edu.
Fetal Diagnosis and Therapy
|April 23, 2023
Summary
Cloacal malformation, a rare congenital anomaly, presents diagnostic challenges prenatally. Early suspicion in female fetuses with pelvic cysts is crucial for timely intervention and improved outcomes.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Congenital Anomalies
Background:
- Cloacal dysgenesis results from incomplete embryonic division of the urogenital sinus and hindgut.
- This leads to a single perineal opening for both genitourinary and gastrointestinal systems.
- Prenatal diagnosis of cloacal malformation is often imprecise.
Observation:
- A 20-week ultrasound revealed anhydramnios and dilated fetal bowel, with fetal MRI confirming these findings plus hydronephrosis and a pelvic cyst.
- A subsequent ultrasound at 27 weeks showed resolution of anhydramnios but new fetal ascites.
- The newborn was diagnosed with cloacal malformation and labial fusion.
Findings:
- Postnatal diagnosis confirmed cloacal malformation.
- The patient underwent initial diversionary surgeries (colostomy, vaginostomy) followed by reconstruction.
- Clinical correlation of postnatal findings with prenatal history aids in understanding complex urogenital abnormalities.
Implications:
- A high index of suspicion for cloacal anomaly is warranted in female fetuses with pelvic cysts.
- Urinary obstruction secondary to cloacal malformation can cause anhydramnios.
- Timely diagnosis and surgical intervention are critical for managing this complex congenital condition.
