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Beyond cloacal malformation. Addressing unclassifiable complexity.

Zeni Haveliwala1, Athanasios Tyraskis2, Kathryn Ford1

  • 1Great Ormond Street Hospital, Department of Paediatric Colorectal Surgery, Great Ormond Street, London, WCN1 3JH, UK.

Journal of Pediatric Surgery
|September 27, 2025
PubMed
Summary
This summary is machine-generated.

Unclassifiable cloacal malformations present unique challenges, often involving complex anatomy and comorbidities. These cases require tailored surgical approaches and experienced multidisciplinary teams for improved functional outcomes.

Keywords:
Anorectal malformationCloacal malformationMultidisciplinary team workingUrogenital malformation

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Area of Science:

  • Pediatric Surgery
  • Congenital Anomalies
  • Urology

Background:

  • Cloacal malformations are complex congenital anomalies with established classification systems.
  • Atypical anatomy in some patients defies standard classification, complicating surgical planning.
  • Existing classification guides reconstructive strategy and prognosis.

Purpose of the Study:

  • To assess management and fecal continence outcomes in unclassifiable cloacal malformation cases.
  • To evaluate the effectiveness of a multidisciplinary service's pathway for these complex cases.

Main Methods:

  • Retrospective review of 82 patients undergoing primary reconstruction since 2010.
  • Patients categorized into classic, posterior, and unclassifiable cloaca groups.
  • Statistical analysis using Fisher's exact and Mann-Whitney U tests.

Main Results:

  • 15 patients (18%) were classified as unclassifiable, presenting with more comorbidities (spinal, renal).
  • Unclassifiable cases underwent more complex surgeries (laparotomy, functional diversion) and had poorer fecal continence (Bowel Function Score 6 vs 13).
  • Higher rates of spinal anomalies requiring neurosurgery (75%) and renal anomalies (93%) were observed in the unclassifiable group.

Conclusions:

  • Unclassified cloacal malformations pose significant management challenges due to complex anatomy and comorbidities.
  • Poorer functional outcomes are associated with anatomical complexity and coexisting anomalies.
  • Successful management necessitates specialized surgical expertise and individualized operative planning.