A six-year-old female presented for definitive procedure of persistent cloaca (Fig. ). She had colostomy on 5th day of life. Ultrasound of abdomen was reported as normal. Distal colostogram showed high recto-cloacal fistula (Fig. ). Endoscopic evaluation revealed an opening at bladder neck. At operation anal sphincter was identified by nerve stimulation and dissection started by making anterior sagittal incision. The sites for the future vagina and ano-rectum were made. Abdomen was then opened by mobilizing the stoma. Urinary bladder was opened and ureteric catheterization done to avoid their damage during surgery. The anomaly was identified as high confluence of rectum and vagina opening into the cloaca at the level of bladder neck (Fig. ). The opening of vagina was very minute that could not be identified on endoscopy as well as at operation. Distal loop of the colon was mobilized and detached from common cloaca. It was tailored distally, to be used as vaginal substitute and pulled down at the perineum, while its proximal end anastomosed with lower end of the vagina that was about 1/3rd in length. Similarly proximal loop of colon mobilized to bring it down as ano-rectum, through the already identified site for anus. Feminizing clitoroplasty was added. The common channel was left as urethra. Finally perineal body was constructed (Fig. ). Patient had uneventful recovery.
Figure 1: Preoperative figure showing single perineal opening.
Figure 2: Distal loopogram showing high insertion of rectum into common channel.
Figure 3: Illustration of the cloacal malformation.
Figure 4: Postoperative showing anorecto-colovagino-urethroplasty.
Examination done after 02 weeks of surgery showed healed patent vaginal and anal passages. On 10th week post operative visit, the mother was satisfied the urinary continence. She observed occasional soiling (Kelly’s continence score 3). She was on follow up and on vaginal dilatation program.