Licayan, Tristan Mark M.

Master of Science in Nursing Medical Surgical Nursing

CLOACAL MALFORMATION
Definition
A persistent cloaca or cloacal malformation is a complex anorectal and
genitourinary malformation, in which the rectum, vagina, and urinary tract meet
and fuse, creating a cloaca, a single common channel.
Cloacal anomalies occur in 1 per 20,000 live births. They occur exclusively in girls
and comprise the most complex defect in the spectrum of anorectal malformations.
Problem Areas
Cloacas appear in a wide spectrum of variation in females born with the
malformation. The single orifice, called a common channel, may occur varying in
length from 1 to 10 cm. The length of the common channel can be used to judge
prognostic outcomes and technical challenges during surgical repair. A common
channel less than 3 cm in length usually has good sphincter muscles and a welldeveloped sacrum.
More than 80% of all patients with a cloaca experience an associated urogenital
anomaly.
Persistent cloaca - 90%
Rectobladderneck fistula - 84%
Rectoprostatic urethral fistula - 63%
Rectovestibular fistula - 47%
Rectobulbar urethral fistula - 46%
Rectoperineal fistula - 26%
Anorectal malformation with no fistula - 31%
Diagnostics
Patients with an untreated obstructive uropathy may have acidosis, or decreased
glomerular filtration rate, as demonstrated by an elevated cystatin C.
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).
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.
Cystoscopy and vaginoscopy are also essential components for evaluation of the
patient with persistent cloaca.
Trends in Treatment
The prognostic outcomes for this type of cloaca are good for bowel control and
urinary function. The surgical repair for this type of cloaca can usually be done by
performing posterior sagittal approach without opening of the abdomen. A common
channel longer than 3 cm in length usually has poor sphincter muscles and a poor
sacrum, suggesting a prognostic outcome for bowel control and urinary function to
be less likely. Common channels longer than 3 cm are generally considered more
complex and more technically challenging in surgical repair.
Learning Insights
Reading on the description regarding the presentation of cloacal malformation, it
interests me that his sort of disfigured minority is possible. Having a single channel
for rectal, urinary, and genital functions could pose serious dangers for the newborn
involved. Not only with physical hazards, but also emotional and mental issues in
the long run. That is why, as a health care provider and patient advocate, us nurses
should stress on proper coping mechanisms and strategies in order to properly
manage not only the growth of the child but also with support of the family.