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Cloacal Exstrophy and Covered Cloacal Exstrophy

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Surgical Treatment of Colorectal Problems in Children

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Abstract

A plea for a unified management of this devastating defect is presented. These patients suffer from serious gastrointestinal, urologic, orthopedic, and neurosurgical defects and are frequently treated with emphasis in one particular area, not putting enough attention to other anatomic territories. An effort should be made to integrate different specialized teams to create a unified approach. In addition, these patients should be treated in specialized centers dedicated to the management of complex anorectal, urogenital, and orthopedic malformations. The importance of comprehensive multidisciplinary approach is emphasized. The authors present their experience, one of the largest in the literature. Special emphasis is placed on the fact that there is a misconception consisting in believing that these patients will remain with an intestinal stoma for life. Also, a frequent serious mistake done during the early management of these cases consists in opening an ileostomy. The authors put emphasis on the fact that leaving an unused defunctionalized distal colon attached to the urinary tract has serious negative implications for these patients and, therefore, describes the best potential initial neonatal approach, creating a real end colostomy and bringing together all portions of the gastrointestinal tract, separated from the urinary tract. Also, the authors emphasize the importance of not making any decisions to use the gastrointestinal tract to repair the urinary tract until the decision has been reached on whether or not the patient is a candidate for a pull-through.

Covered Cloacal Exstrophy: An important group of patients is presented that have intra-abdominal anatomic findings very similar to those of the cloacal exstrophy, yet the abdominal wall is intact. Therefore, these patients require an important index of suspicion in order to make the right diagnosis. They do not have a bladder neck, and therefore, they have a very small bladder that will need further reconstruction such as in patients with cloacal exstrophy. Frequently they have also the same abnormal type of colon seen in patients with cloacal exstrophy. Illustrations are presented to alert the clinicians about the diagnosis of this malformation in order to have a good surgical plan and adjust the parents’ expectations for the future of these babies.

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  1. Pediatric Surgery, Colorectal Center for Children Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Alberto Peña & Andrea Bischoff

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Peña, A., Bischoff, A. (2015). Cloacal Exstrophy and Covered Cloacal Exstrophy. In: Surgical Treatment of Colorectal Problems in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-14989-9_17

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  • DOI: https://doi.org/10.1007/978-3-319-14989-9_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14988-2

  • Online ISBN: 978-3-319-14989-9

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