| Autor: |
I. Sau, Duncan T. Wilcox, S.A. Warne |
| Rok vydání: |
2004 |
| Předmět: |
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| Zdroj: |
The Journal of urology. 171(3) |
| ISSN: |
0022-5347 |
| Popis: |
Cloaca is a rare anomaly affecting a wide spectrum of anatomy. Posterior cloaca is a variation that involves the cloacal channel ending in the rectum. We describe 2 cases of an unusual variety of posterior cloaca. CASE HISTORIES Case 1. A female newborn presented with an abdominal mass arising from the pelvis, a normally sited anal opening and a single opening at the introitus. She passed urine and meconium through the 2 openings separately. Imaging revealed a complete duplex system on the left side with a poorly functioning upper moiety draining ectopically. The right side was an incomplete duplex. There was a short sacrum but no cord tethering. Examination with the patient under anesthesia and cystoscopy showed a urogenital sinus with a common channel of 3 cm and a capacious vagina. The vagina was decompressed and the patient was started on clean intermittent catheterization. At cystovaginoscopy the patient had an H-type fistulous connection from the posterior wall of the urogenital sinus to the anal canal. This finding was confirmed at operation (see figure). During surgical reconstruction via the perineal approach the fistula was opened and the vaginal wall was mobilized off the rectum. The common channel was mobilized and then opened onto the perineum, creating separate urethral and vaginal openings. An upper pole duplex ureter also drained into the upper vagina and was removed by right upper pole heminephrectomy. The patient recovered well and at age 3 years she is dry during the day and in diapers at night. She has regular bowel movements. Case 2. At 26 weeks of gestation a female fetus was diagnosed with left renal agenesis and right hydronephrosis. Serial scans demonstrated increasing right hydronephrosis with a subsequent perinephric urinoma, which was shunted by pelvic amniotic shunt at 31 weeks. The patient was born at 37 weeks by normal vaginal delivery with a turbulent neonatal period, and required peritoneal dialysis and right nephrostomy. Right end ureterostomy was performed. She was noted to have an anterior anal opening and a single opening at the introitus. Cystovaginoscopy revealed a common channel of 1 cm with a small hypoplastic bladder. There were hemivaginae and hemiuteri and rectal duplication, and an H-type fistulous connection between the urogenital sinus and the anterior wall of the rectum with a good external anal sphincter. After renal function stabilized the patient underwent surgery by posterior sagittal approach at age 1 year. The septum between the 2 hemivaginae was divided with mobilization of the short common channel to create separate urethral and vaginal openings. The fistula was excised. Rectal duplication was excised and the neorectum was placed in the middle of the sphincter complex. DISCUSSION |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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