How are cloacal deformities treated?
Cloacal deformities require surgical repair. The treatment plan devised for your child will depend on the type and extent of the abnormality.
Stabilizing your newborn
Before a treatment plan to correct your baby's anatomy is put in place, your doctors' immediate concern will be to stabilize her condition. This may involve the creation of a diverting colostomy to allow the passage of stool. With a colostomy, the large intestine is divided into two sections and the ends of the intestine are brought through surgically created openings (stomas) in the abdomen. The upper section allows stool to pass into a collection bag, while the lower section allows for drainage of mucus produced by the intestine.
The urinary bladder may also need to be decompressed to relieve obstruction of urine flow from the bladder and, at times, the kidney. Some children will be able to void urine on their own, but for others, intermittent catheterization may be needed to help eliminate urine. The vagina must also be decompressed to allow it to drain.
After stabilization, and when your baby has had a chance to grow, the anatomic features of the deformity will be clarified, and a definitive correction will be planned. The treatment typically involves the surgical creation of a urethra and vagina. In some children with less severe deformity, the urethra and vagina are intact and they do not need to be created, but simply have their openings brought to the skin surface. Finally, a reconstruction of the bowel, through a procedure called a "pull-through" of the colon, must be completed. For this procedure, the surgeon may have to open the abdomen to complete the connection of the colon to the rectum.
Follow-up and further surgery
Once healing is assured, a third operation will close the colostomy and reestablish normal bowel movements through the rectum. Further urinary or genital tract surgery may also be needed.
What is the long-term outlook for a child with a cloacal deformity?
The outlook for a child with a cloacal deformity depends on a number of factors, including the extent of the problem, associated anomalies, whether the sacrum is affected, and the technical exactness and healing of the operative procedure used to correct the problem. Physicians and surgeons at Children's have a great deal of experience treating children with all kinds of cloacal deformities.
Mild deformity - More mild cases generally have a favorable long-term outlook. These children usually have excellent bladder control, normal sexual development and function (including fertility) and a near normal pattern of bowel movements.
Severe deformity - 70 to 80 percent of children will have a very favorable outlook with good to excellent stool control and only infrequent episodes of leakage or incontinence. The other 20 to 30 percent, depending on the degree of associated problems, will likely need a life-long bowel and/or urinary bladder management program with a variety of medical and surgical interventions (as needed) to improve their quality of life.