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Cloacal Malformations Workup

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Cloacal Malformations Workup

Author: Marc A Levitt, MD; Chief Editor: Marleta Reynolds, MD more... Updated: Apr 17, 2012

Laborator Studies
Patients with an untreated obstructive uropathy may have acidosis, or decreased glomerular filtration rate, as demonstrated by an elevated cystatin C.

Imaging Studies
Newborn period
The radiologic evaluation of a newborn with persistent cloaca includes abdominal ultrasonography to evaluate for urologic anomalies and a distended vagina (hydrocolpos). Plain radiography of the spine can show spinal anomalies, such as spina bifida and spinal hemivertebrae. Plain radiography of the sacrum in the anterior-posterior and lateral projections can reveal sacral anomalies, such as a hemisacrum and sacral hemivertebrae. Also, the degree of sacral hypodevelopment can be assessed, and a sacral ratio can be calculated by measuring the distances between key bony structures (see the image below).

Calculation of the sacral ratio.

Spinal ultrasonography in patients younger than 3 months can be performed to evaluate for evidence of a tethered spinal cord and other spinal anomalies. In patients older than 3 months, the radiologist cannot visualize this area with ultrasonography because ossification of the sacrum has occurred, closing the window for ultrasonographic visualization.

After the newborn period

After the colostomy has been created, outpatient radiologic evaluation of the cloaca involves injection of hydrosoluble contrast in all possible orifices in order to determine the anatomy. Injection of the perineal orifice, distal colostomy, the cystostomy tube, and the vaginostomy tube, if present, may all contribute to defining the anatomy. A colostomy with a mucous fistula is essential because the anatomy can be radiologically investigated through the distal stoma.
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Cloacal Malformations Workup

MRI is necessary in infants older than 3 months to evaluate for the presence of tethered cord and other spinal anomalies if ultrasonography was not performed in the neonatal period.

Other Tests
Cystoscopy and vaginoscopy are essential components for evaluation of the patient with persistent cloaca. Many surgeons choose to perform endoscopy before the main repair so that the anatomy can be defined and the complex surgery can be planned. With the information obtained from the endoscopy, the surgeon can usually predict whether a laparotomy will be required in combination with the perineal approach. Insight into the extent of vaginal reconstruction needed can also be ascertained. The anatomic questions that can be answered include the following: The length of the common channel The presence of a vagina The presence of hemivagina The presence of a cervix (or cervices) The visualization of the rectal fistula

Contributor Information and Disclosures

Author Marc A Levitt, MD Professor of Surgery, University of Cincinnati; Director, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center Marc A Levitt, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and Society of American Gastrointestinal and Endoscopic Surgeons Disclosure: Nothing to disclose. Coauthor(s) Alberto Pena, MD Founding Director, Colorectal Center for Children, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center Alberto Pena, MD, is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, American Society of Colon and Rectal Surgeons, Pacific Association of Pediatric Surgery, and Royal College of Surgeons of England Disclosure: Nothing to disclose. Specialty Editor Board Aviva L Kat , MD Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society Disclosure: Nothing to disclose. Mar L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Gail E Besner, MD John E Fisher Endowed Chair in Neonatal Reseach, Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental
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Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons Disclosure: Nothing to disclose. H Biemann Othersen Jr, MD Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association Disclosure: Nothing to disclose. Chief Editor Marleta Re nolds, MD Professor of Surgery, Northwestern University, The Feinberg School of Medicine; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association Disclosure: Nothing to disclose.

References
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