Posterior cloaca: a unique defect

Area of Science:

• Pediatric Surgery
• Urology
• Gynecology

Background:

• Describes a rare congenital anomaly: posterior cloaca, characterized by fused urethra and vagina forming a urogenital sinus.
• This sinus deviates posteriorly, opening into the anterior rectal wall, near or at the anus.
• The rectum is typically normal or slightly anteriorly displaced.

Purpose of the Study:

• To report on nine cases of posterior cloaca, a unique congenital defect.
• To emphasize the diagnostic challenges and the necessity of a thorough genital examination.
• To highlight the high incidence of associated urologic anomalies and the importance of complete urologic evaluation.

Main Methods:

• Diagnosis relies on careful clinical observation and meticulous examination of female genitalia.
• A complete urologic evaluation was performed for all patients due to high association rates.
• Surgical correction was performed using a posterior sagittal transanorectal approach.

Main Results:

• The posterior sagittal transanorectal approach facilitated dissection and repositioning of the urethra and vagina.
• Rectal dissection was minimized to preserve anorectal function and continence.
• Seven out of nine patients achieved good bowel and urinary control post-surgery.

Conclusions:

• Posterior cloaca is a rare defect requiring vigilant diagnosis.
• The posterior sagittal transanorectal approach is effective for surgical correction, preserving rectal function.
• While functional outcomes are generally positive, severe sacral dysgenesis can lead to incontinence.