1
|
Lazarte-Rantes C, Chirinos-Gambarini M, Sulca-Cruzado GJ, Ramirez-De la Cruz R, Trigoso V, Cerron-Vela C, De la Torre-Mondragon L. T2-based magnetic resonance genitography in children with complex anorectal malformations: experience at a tertiary pediatric hospital in Latin America. Pediatr Radiol 2024; 54:430-437. [PMID: 38273134 DOI: 10.1007/s00247-023-05849-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
In children with anorectal malformations (ARMs), it is essential to have a diagnostic imaging method that helps with the evaluation of the internal anatomy. In patients with a persistent cloaca, an ARM variant, in which the measurement of the urethral channel and common channel determines surgical management, there are multiple options for imaging. Magnetic resonance imaging (MRI) is an excellent method for this purpose, from which accurate measurements of channel length can be obtained. Additionally, the use of volumetric/isotropic sequences allows multiplanar reformatting. We present our experience with pelvic MRI and intracavitary non-paramagnetic contrast (MR genitography). This method uses volumetric T2-weighted images and the instillation of saline solution as a contrast agent to distinguish the common channel, length of the urethra, anatomy of the vagina, and presence and location of the rectal fistula. We believe this technique to be particularly useful for those working in settings with limited MRI resources.
Collapse
Affiliation(s)
- Claudia Lazarte-Rantes
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru.
| | - Mario Chirinos-Gambarini
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | | | - Raul Ramirez-De la Cruz
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Victor Trigoso
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Carmen Cerron-Vela
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luis De la Torre-Mondragon
- International Center for Colorectal and Genitourinary Care, Children's Hospital Colorado, Denver, CO, USA
| |
Collapse
|
2
|
Vacaru A, Won MM, Raymond SL, Chamberlin JD, Radulescu A. Cloacal Dysgenesis Sequence in a Preterm Neonate. Am J Case Rep 2024; 25:e942203. [PMID: 38412145 PMCID: PMC10910718 DOI: 10.12659/ajcr.942203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/23/2024] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Cloaca malformations result from a disproportion of apoptosis, cell growth, and maturation. The range of cloacal malformations is extensive and diverse, with a lack of a straightforward classification system. Cloacal dysgenesis sequence (CDS), also known as urorectal septum malformation sequence, is a rare cloaca variant described as the absence of a perineal orifice. Prenatal magnetic resonance imaging and antenatal ultrasounds may reveal a cloacal malformation; however, many patients are not diagnosed with cloacal malformation until birth. CASE REPORT We present a case of a female neonate delivered by a 23-year-old G2P1T1A0L0 mother who had received comprehensive prenatal care. During pregnancy, bilateral multicystic dysplastic kidneys were identified prenatally, leading to the in utero placement of a vesicoamniotic shunt. The physical exam revealed a distended abdomen with reduced abdominal musculature and laxity, ascites, a vesicoamniotic shunt in place, absent urethra, ambiguous genitalia with no vaginal opening, no perineal opening, and clubfoot. Abdominal radiograph showed findings consistent with significant abdominal ascites. An exploratory laparotomy was performed that included diverting colostomy, mucous fistula creation, tube vaginostomy, removal of the vesicoamniotic shunt, and suprapubic tube placement. The patient recovered well from this operation with no complications. CONCLUSIONS CDS is an uncommon condition in pediatric patients, and although sonographic findings can reveal urinary tract abnormalities, prenatal imaging might not always identify CDS. Our case underscores the uniqueness of the case and the significance of early detection and immediate medical and surgical intervention.
Collapse
Affiliation(s)
| | - Mitchell M. Won
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Steven L. Raymond
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Joshua D. Chamberlin
- Division of Pediatric Urology, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| |
Collapse
|
3
|
Abdelmaksoud S, Lobo S, Cho A, Upasani A, Blackburn S, Curry J, Davies B, Martin R, De Win G, Cherian A. Fetal ascites in cloacal malformations-a red flag. Pediatr Surg Int 2023; 39:293. [PMID: 37971531 DOI: 10.1007/s00383-023-05564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cloacal malformation is a rare anomaly that remains a diagnostic challenge prenatally, despite the current advances in ultrasonography and MRI. This condition can in some, present with isolated ascites or with other findings, such as a pelvic cyst or upper urinary tract dilatation. In a minority, the ascites may be progressive, questioning the role of antenatal intervention. METHODS We report on ten patients that have been identified from our Cloaca database between 2010 and 2022. RESULTS The presence of ascites was associated with extensive bowel adhesions and matting, leading to a challenging initial laparotomy and peri-operative course. CONCLUSIONS Antenatal finding of ascites in newborns with cloacal malformations should raise a red flag. The surgeon and anaesthetist should be prepared for the operative difficulties secondary to bowel adhesions and the higher risk of haemodynamic instability at the initial surgery. An experienced team at initial laparotomy in such patients is vital. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Sherif Abdelmaksoud
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sara Lobo
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexander Cho
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anand Upasani
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Blackburn
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Brian Davies
- Department of Paediatric Surgery, Nottingham Childrens Hospital, Nottingham, UK
| | - Ruppert Martin
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Gunter De Win
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| |
Collapse
|
4
|
Ozcan T, Woo L, Wien M, Lazebnik N. Prenatal ultrasound findings of covered bladder exstrophy and persistent cloaca. J Clin Ultrasound 2021; 49:834-837. [PMID: 34235755 DOI: 10.1002/jcu.23036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/19/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Unlike classic exstrophy, covered bladder exstrophy is a rare variant characterized by a cycling bladder and intact abdominal wall. We present a case of covered bladder exstrophy diagnosed prenatally and associated persistent cloaca (PC) noted only after delivery. This case report demonstrates that prenatal diagnosis of covered bladder exstrophy is possible and PC can present without any abdominal cysts, bowel, or renal findings. Covered bladder exstrophy should be considered in the differential of cystic protrusion of the bladder to the abdominal wall.
Collapse
Affiliation(s)
- Tulin Ozcan
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lynn Woo
- Department of Pediatric Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Michael Wien
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Noam Lazebnik
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
5
|
Lin X, Xu X, Yang Y, Wu J, Xian X, Chen X. Preoperative evaluation of persistent cloaca using contrast-enhanced ultrasound in an infant. Med Ultrason 2020; 22:250-252. [PMID: 32190857 DOI: 10.11152/mu-2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Persistent cloaca (PC) is the most intricate anorectal malformation. Contrast-enhanced ultrasound (CEUS) is safe for hepatic, renal, splenic, vascular, and intracavitary assessment in children, but it is little applied for cloacal malformation. Our results demonstrate that CEUS can not only display the uterine, vagina, bladder, urethra, rectum, and rectovaginal fistula, but also measure the length of the common channel, bladder neck to the common channel, and distal urethra to the perineum. To our knowledge this may be the first report of preoperative evaluation by CEUS in an infant with PC.
Collapse
Affiliation(s)
- Xueyun Lin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Xiaohong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Yuping Yang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Jiang Wu
- Department of Pediatric Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Xiaohui Xian
- Department of Pediatric Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Xiaodong Chen
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| |
Collapse
|
6
|
Abstract
PURPOSE The association of gynecological anomalies in all anorectal malformations (ARM) is firmly established. Our goal is to study this pathology in our patients to focus attention to this important issue. METHODS Retrospective study of female patients operated for ARM and who underwent magnetic resonance imaging in our center. The type of malformation, the presence and type of vaginal, uterine, tubaric and urological anomalies were studied. RESULTS 63 patients were included: 34.9% cloaca, 28.6% vestibular and 12.7% perineal. Half of patients had some type of müllerian anomaly; 19 vaginal, most frequent being the longitudinal vaginal septum (66.7%); 30 had uterine alterations, most frequent being the uterus didelphys (60%). Eighty percent of patients with complex ARM (cloaca, exstrophy) presented some type of gynecological malformation compared to 21.8% found in simple ARM (stenosis, perineal, vestibular) (p < 0.001). Vaginal anomalies are associated with a uterine anomaly in 100% of cases. Conversely, patients with uterine anomalies have concurrent vaginal anomaly in 63.3% of cases. CONCLUSION Screening for gynecological anomalies is indicated in all patients with ARM. We recommend a vaginal examination in any girl with ARM during definitive repair and a subsequent MRI during follow-up. Collaboration with a gynecologist is essential.
Collapse
Affiliation(s)
- María Fanjul
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Angel Lancharro
- Pediatric Radiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Esther Molina
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Julio Cerdá
- Pediatric Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain
| |
Collapse
|
7
|
Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol 2019; 49:387-398. [PMID: 30547222 DOI: 10.1007/s00247-018-4302-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/21/2018] [Accepted: 10/31/2018] [Indexed: 01/13/2023]
Abstract
The term cloacal malformation is commonly used to describe the classic cloacal malformation where there is a single common urogenital and intestinal channel located at the expected site of the urethra. There is, however, a spectrum of cloacal abnormalities that differ from this classic type and are less well discussed in the radiologic and surgical literature. The aim of this pictorial essay is to familiarize radiologists with the anatomy, appropriate terminology and key prenatal imaging findings that differentiate the six entities that constitute the spectrum of cloacal abnormalities.
Collapse
Affiliation(s)
- Kimberly A Dannull
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA.
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lorna P Browne
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
| | - Mariana Z Meyers
- Department of Diagnostic Radiology, Division of Pediatric Radiology,, Children's Hospital Colorado,, 13123 East 16th Ave., Mailbox B-463,, Aurora, CO, 80045, USA
- Department of Radiology,, University of Colorado School of Medicine,, Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
8
|
Abdelhalim A, Arab H, Helmy TE, Dawaba ME, Abou-El-Ghar ME, Hafez AT. Cloacal Duplication: Single-center Experience in the Management of a Rare Anomaly. Urology 2017; 108:171-174. [PMID: 28705578 DOI: 10.1016/j.urology.2017.06.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 11/19/2022]
Abstract
Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs, and vascular structures. Every case is unique and ought to be approached individually. By means of imaging studies and endoscopy, anatomic details should be carefully defined before endorsing surgical correction. A satisfactory outcome can be achieved in the majority of cases. In this report, we describe 3 girls with cloacal duplication, and review pertinent imaging and surgical management.
Collapse
Affiliation(s)
- Ahmed Abdelhalim
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Hesham Arab
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tamer E Helmy
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Dawaba
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Abou-El-Ghar
- Department of Radiology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf T Hafez
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
9
|
Pei Y, Wu Q, Liu Y, Sun L, Zhi W, Zhang P. Prenatal sonographic diagnosis of urorectal septum malformation sequence and chromosomal microarray analysis: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e5326. [PMID: 27828853 PMCID: PMC5106059 DOI: 10.1097/md.0000000000005326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Urorectal septum malformation sequence (URSMS) is a rare congenital abnormal syndrome that is caused by the incomplete division of the cloaca. Based on whether the cloaca membrane breaks down or not, the URSMS are classified as full and partial forms. The prenatal diagnosis of URSMS remains challenging because of poor recognition to this malformation and the relatively non-specific sonographic features. We report a prenatally sonographic diagnosed case of the partial URSMS, and review the literature to summarize the prenatal features. CASE REPORT AND REVIEW A 37-year old woman was referred at 24 weeks of gestation for fetal abdominal cyst. Detailed sonographic examination was done and revealed the vesicocolic fistula, distended colon, absence of perianal hypoechoic ring, pyelectasis, and small stomach bubble. The URSMS was suspected.Amniocentesis was done and karyotyping revealed 46,XY. Furthermore, chromosomal microarray analysis (CMA) was performed for the first time in URSMS and an alteration of 111.8Kb deletion was detected in 16p13.3 which was located inside the RBFOX1 gene. Parental studies showed that the deletion was inherited from the father who has nomal clinical phenotype.The woman elected to terminate the pregnancy at 25 weeks gestation and postmortem examination confirmed the diagnosis of partial URSMS.The published studies were reviewed and 28 cases of URSMS with conducted prenatal ultrasonography were collected in this report. The most common sonographic description, as suspicious signs of URSMS, were severe oligohydramnios or anhydramnios, urinary tract anomalies, fetal intra-abdominal cysts, and dilated bowel. Also, enterolithiasis and vesicocolic fistula were relatively infrequent but highly specific feature of URSMS. CONCLUSIONS URSMS is difficult to be diagnosed prenatally. However, it has characteristic features that can be detected by fetal ultrasonography, and a precise prenatal sonographic examination is crucial for diagnosing URSMS. Besides, more genomic profiling studies are needed to elucidate the causality.
Collapse
Affiliation(s)
| | - Qingqing Wu
- Department of Ultrasound
- Correspondence: Qingqing Wu, Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China (e-mail: )
| | | | | | - Wenxue Zhi
- Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | | |
Collapse
|
10
|
Abstract
Cloacal malformation is a rare but important anomaly. Prenatal diagnosis is possible with knowledge of the distinctive imaging features. The purpose of this case series is to illustrate characteristic prenatal sonographic and magnetic resonance imaging features of cloacal malformation using imaging from 6 cases seen at a single academic center to augment published data. The imaging feature common to all cases was a central cystic pelvic mass containing a characteristic fluid-fluid level. Additional anomalies include uterine and vaginal duplication, hydronephrosis, and lumbosacral anomalies. Prenatal magnetic resonance imaging showed the absence of the normal T1-hyperintense meconium-filled rectum in all cases. Prenatal diagnosis may affect immediate neonatal care (eg, immediate drainage of hydrocolpos) with an ultimate improved outcome.
Collapse
Affiliation(s)
- Nicole S Winkler
- Department of Radiology, University of Utah, 30 N 1900 E, 1A071, Salt Lake City, UT 84132, USA.
| | | | | |
Collapse
|
11
|
Chen CP, Chang TY, Hsu CY, Liu YP, Tsai FJ, Wu PC, Wang W. Persistent cloaca presenting with a perineal cyst: Prenatal ultrasound and magnetic resonance imaging findings. J Chin Med Assoc 2012; 75:190-3. [PMID: 22541150 DOI: 10.1016/j.jcma.2012.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/23/2011] [Indexed: 11/25/2022] Open
Abstract
A 40-year-old, primigravid woman presented at 23 weeks of gestation for evaluation of an extra-abdominal echogenic cystic mass of the fetus. Amniocentesis revealed a karyotype of 46,XX. Prenatal ultrasound showed a two-vessel umbilical cord, hydrocolpos, and distended bladder, urethra, and colon, and a perineal cystic mass. The kidneys and amniotic fluid amount were normal. Fetal magnetic resonance imaging revealed ascites, hydrocolpos, distended urinary bladder and colon, high rectum, and a perineal cyst. The fetus postnatally manifested persistent cloaca. The perineum was distended and smooth, without patent anal, vaginal, and urethral openings. The external genitalia were ambiguous with no labia majora, labia minora, or clitoris. The perineal cyst had a very small single orifice. We suggest that cloacal anomalies be considered in any female fetus with hydrocolpos, distended bladder and colon, ascites, and a perineal cyst.
Collapse
Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
| | | | | | | | | | | | | |
Collapse
|
12
|
Goyal A, Fishwick J, Hurrell R, Cervellione RM, Dickson AP. Antenatal diagnosis of bladder/cloacal exstrophy: challenges and possible solutions. J Pediatr Urol 2012; 8:140-4. [PMID: 21641871 DOI: 10.1016/j.jpurol.2011.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/10/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify the pitfalls in accurate antenatal diagnosis of bladder exstrophy (BE) and cloacal exstrophy (CE), and thus understand the challenges for antenatal counselling. METHODS A prospectively maintained bladder exstrophy database of antenatal and live born referrals for BE/CE was used to identify patients. Data were collected about the antenatal scan findings and the outcome of pregnancy. RESULTS Between 2003 and 2009, 40 new babies with BE/CE were referred and of them 10 had an antenatal diagnosis. Five patients did not have a diagnosis despite suspicious findings noted on antenatal scans and another three had a wrong diagnosis of BE/CE. Of the 16 referrals with antenatal suspicion of BE/CE, 5 opted for termination. At the 20-week scan, it was possible to identify the gender of the fetus in 3/16 cases only. CONCLUSIONS Only a quarter of the babies born with BE/CE had received an antenatal diagnosis. Raising awareness about the condition amongst radiographers, and facilitating further scanning by a specialist fetal management unit if suspicious findings are noted, is crucial for improving the rate of detection. An antenatal diagnosis may not be reliable, and difficulty in identifying gender at the 20-week scan adds to the complexity of antenatal counselling. Magnetic resonance imaging and karyotyping may provide additional helpful information.
Collapse
Affiliation(s)
- Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.
| | | | | | | | | |
Collapse
|
13
|
Livingston JC, Elicevik M, Breech L, Crombleholme TM, Peña A, Levitt MA. Persistent cloaca: a 10-year review of prenatal diagnosis. J Ultrasound Med 2012; 31:403-407. [PMID: 22368130 DOI: 10.7863/jum.2012.31.3.403] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to review antenatal sonographic findings in children born with persistent cloaca. METHODS Infants (n =145) with persistent cloaca followed at a center for colorectal congenital anomalies were identified by a retrospective chart review. Fifty female infants with a persistent cloaca met inclusion criteria and had prenatal records and imaging studies available for review. Sonographic data were retrospectively abstracted from charts. RESULTS Anomalies were detected in 27 of 50 cases (54%). A correct antenatal diagnosis of persistent cloaca occurred in 3 of 50 (6%). Common findings misinterpreted on antenatal sonography include urinary tract anomalies, dilated bowel, and a cystic pelvic mass (representing hydrocolpos). CONCLUSIONS Antenatal diagnosis of persistent cloaca is difficult. Persistent cloaca should be considered in the differential diagnosis if urinary tract malformations, dilated bowel loops, or cystic pelvic masses are visualized by prenatal diagnosis.
Collapse
Affiliation(s)
- Jeffrey C Livingston
- Department of Obstetrics and Gynecology, East Carolina University, Brody School of Medicine, Greenville, North Carolina 27834, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Witters I, Meylaerts L, Peeters H, Coumans A, Wirjosoekarto S, Fryns JP. Fetal hydrometrocolpos, uterus didelphys with low vaginal and anal atresia: difficulties in differentiation from a complex cloacal malformation: a case report. Genet Couns 2012; 23:513-517. [PMID: 23431753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hydrometrocolpos, occurring in approximately 1/6000 newborn girls, can be caused by a stenotic urogenital sinus, a severe cloacal malformation, but also by other conditions such as an imperforate hymen, a midline vaginal septum and vaginal atresia. The prenatal differential diagnosis of this wide spectrum of conditions is not easy and requires a multidisciplinary approach with follow-up scans and MRI to access the severity of the condition. A non-consanguineous couple was referred in the first pregnancy at 30 weeks. The father, 30 years of age, of Kaukasian origin, and the mother of Asian origin, 26 years of age. Ultrasound at 30 weeks revealed ambiguous genitalia (with suspicion of clitoral hypertrophy), a septated structure located behind the bladder compatible with hydrometrocolpos with a uterine malformation (uterus didelphys), a single umbilical artery, mild ascites and growth on the tenth centile. The differential diagnosis included a vaginal atresia, a urogenital sinus and a more severe cloacal malformation. After serial scans, MRI and counselling by an experienced surgeon the preferential diagnosis of a cloacal malformation was made and a late pregnancy termination was performed. Pathological examination revealed: low vaginal atresia with uterus didelphys, anal atresia with rectovaginal fistula and a normal urinary tractus. The differential diagnosis between hydrometrocolpos due to vaginal atresia or due to a more severe cloacal malformation is not straightforward. Care should be taken in decision making and counselling patients with these complex prenatal malformations.
Collapse
Affiliation(s)
- I Witters
- Center for Human Genetics, Catholic University of Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
15
|
Calvo-Garcia MA, Kline-Fath BM, Levitt MA, Lim FY, Linam LE, Patel MN, Kraus S, Crombleholme TM, Peña A. Fetal MRI clues to diagnose cloacal malformations. Pediatr Radiol 2011; 41:1117-28. [PMID: 21409544 DOI: 10.1007/s00247-011-2020-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 12/29/2010] [Accepted: 02/07/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis. OBJECTIVE To define the prenatal MRI findings in cloacal malformations. MATERIALS AND METHODS We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses. RESULTS The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5-6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos. CONCLUSION Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified.
Collapse
Affiliation(s)
- Maria A Calvo-Garcia
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
INTRODUCTION Prenatal diagnosis of anorectal malformations currently occurs in 0-15.9% of screened cases. In cloacas, these numbers are unknown. We speculate that some images from prenatal ultrasound studies may suggest the diagnosis of cloaca, but are not recognized because of a lack of suspicion for this diagnosis. METHODS A retrospective review of the medical records of 489 patients born with cloaca was performed; 95 of them had prenatal ultrasound reports that represent the material analyzed for this study. A literature review was performed, finding 31 publications, with 68 cloaca patients detected by prenatal images. The abnormal findings of our patients were compared with those described in the literature to determine the most common abnormal prenatal images found in patients with cloaca. RESULTS The 95 ultrasound reports found in our patients described 270 abnormalities, the most frequent were: abdominal/pelvic cystic/mass (39), hydronephrosis (36), oligohydramnios (23), distended bowel/bowel obstruction (19), ascites (15), 2 vessel cord (14), dilated bladder (14), dilated ureter (14), polyhydramnios (10), echogenic bowel (8), multicystic kidney (8), "ambiguous genitalia" (7), hydrops fetalis (7), hydrocolpos (4), absent kidney (3), abnormal spine (3), and anorectal atresia (3). In spite of these findings, the radiologists who interpreted the studies only suspected a cloaca in 6 cases (6%). The literature review showed 212 abnormalities in 68 demonstrated cloaca patients. The most frequent were: abdominal/pelvic cystic/mass (46), hydronephrosis (44), ascites (21), oligohydramnios (20), distended bowel (11), multicystic dysplastic kidney (7), ambiguous genitalia (6), non-visualization of the bladder (6), two-vessel cord (5), dilated bladder (5), intraabdominal calcification (4), polyhydramnios (4), enterolithiasis (4), hydrometrocolpos (3), and dilated ureter (3). CONCLUSION We conclude that it is possible to suspect the diagnosis of cloaca, prenatally, more frequently than what currently occurs, looking at the same images but with an increased index of suspicion for cystic abdominal masses and a combination of gastrointestinal and urological abnormalities.
Collapse
Affiliation(s)
- Andrea Bischoff
- Colorectal Center for Children, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229, USA.
| | | | | | | | | |
Collapse
|
17
|
Shono T, Taguchi T, Suita S, Nakanami N, Nakano H. Prenatal ultrasonographic and magnetic resonance imaging findings of congenital cloacal anomalies associated with meconium peritonitis. J Pediatr Surg 2007; 42:681-4. [PMID: 17448765 DOI: 10.1016/j.jpedsurg.2006.12.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Cloacal malformations are rare anomalies, occurring in females, and in which they demonstrate a single perineal orifice for urethra, vagina, and rectum. Prenatal ultrasonograms (US) of cloacal malformations sometimes show ascites, hydrocolpos, and hydronephrosis. We herein describe the characteristic prenatal US and magnetic resonance imaging (MRI) findings of the cloacal malformations associated with meconium peritonitis. METHODS The pre- and postnatal records of 11 newborn patients with cloacal malformations, treated in our hospital from 1988 to 2004, were reviewed. All fetuses underwent prenatal US by experienced obstetricians, whereas in addition, fetal MRI was performed in 1 patient. RESULTS The prenatal US and/or MRI findings showed fetal ascites, a multicystic pelvic mass, oligohydramnios, and bilateral hydronephrosis in 5 of 11 patients with cloacal malformations. In these 5 cases, postnatal examinations showed associated hydrocolpos, hydrometrocolpos, and bilateral hydronephrosis; furthermore, 4 of these 5 cases also showed meconium peritonitis at laparotomy. CONCLUSIONS The prenatal US and MRI findings, showing fetal ascites, multicystic pelvic mass, bilateral hydronephrosis, and oligohydraminios are highly suggestive of the cloacal malformations associated with meconium peritonitis.
Collapse
Affiliation(s)
- Takeshi Shono
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| | | | | | | | | |
Collapse
|
18
|
Dulay AT, Schwartz N, Laser A, Greco MA, Monteagudo A, Timor-Tritsch IE. Two- and 3-dimensional sonographic diagnosis of a vesicorectal fistula in cloacal dysgenesis sequence. J Ultrasound Med 2006; 25:1489-94. [PMID: 17060441 DOI: 10.7863/jum.2006.25.11.1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Antonette T Dulay
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University School of Medicine, New York, NY 10016 USA
| | | | | | | | | | | |
Collapse
|
19
|
Adams ME, Hiorns MP, Wilcox DT. Combining MDCT, micturating cystography, and excretory urography for 3D imaging of cloacal malformation. AJR Am J Roentgenol 2006; 187:1034-5. [PMID: 16985153 DOI: 10.2214/ajr.05.0117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
20
|
Cianciosi A, Mancini F, Busacchi P, Carletti A, de Aloysio D, Battaglia C. Increased amniotic fluid volume associated with cloacal and renal anomalies. J Ultrasound Med 2006; 25:1085-90. [PMID: 16870904 DOI: 10.7863/jum.2006.25.8.1085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Arianna Cianciosi
- Department of Obstetrics and Gynecology, Alma Mater Studiorum-University of Bologna, 13-40138 Bologna, Italy
| | | | | | | | | | | |
Collapse
|
21
|
Romeo C, Arena F, Impellizzeri P. [Prenatal diagnosis of pelvic floor malformations]. Pediatr Med Chir 2005; 27:59-63. [PMID: 16910452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Pelvic floor malformations are congenital defects in the pelvic and perineal area, which are derived from a defective development of the cloaca membrane, the uro-rectal septum, the mesonephric and para-mesonephric ducts and the urogenital sinus. These are complex anomalies with a profound emotional impact on parents. The prenatal diagnosis is possible favoring the prenatal counseling for the parents and expediting the post-natal evaluation and management. Aim of the present paper is to review the current criteria for the prenatal diagnosis of the following malformations: anorectal anomalies, cloacal anomalies, persistence of the urogenital sinus, bladder and cloacal exstrophy and ambiguous genitalia.
Collapse
Affiliation(s)
- Carmelo Romeo
- Dipartimento di Scienze Pediatriche Mediche e Chirurgiche, Università degli Studi di Messina
| | | | | |
Collapse
|
22
|
Taipale P, Heinonen K, Kainulainen S, Seuri R, Heinonen S. Cloacal anomaly simulating megalocystis in the first trimester. J Clin Ultrasound 2004; 32:419-422. [PMID: 15372451 DOI: 10.1002/jcu.20063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We present a case of cloacal anomaly that simulated megalocystis in the first trimester of gestation of a female fetus. During the second trimester, repeated paracentesis was necessary to treat increasing ascites, oligohydramnios, and hydronephrosis. Our data support findings that ascites presenting with a multiloculated cystic structure on sonography during the second trimester may be typical for cloacal anomalies. Active treatment of the fetal ascites is recommended to improve the child's prospects for survival.
Collapse
Affiliation(s)
- Pekka Taipale
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland
| | | | | | | | | |
Collapse
|
23
|
Chaubal N, Dighe M, Shah M, Chaubal J, Raghavan J. Calcified meconium: an important sign in the prenatal sonographic diagnosis of cloacal malformation. J Ultrasound Med 2003; 22:727-730. [PMID: 12862274 DOI: 10.7863/jum.2003.22.7.727] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cloacal malformation is a rare abnormality, characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis is difficult because of nonvisualization of the communication. We report a case of prenatal diagnosis of this condition, in which the recognition of calcified meconium in the colon and urinary tract provided an important clue.
Collapse
Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Centre, Shanti Niwas, Dr Moose Road,Taloapali, Thane (W) 400 601, Maharashtra, India
| | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND/PURPOSE The embryology of bladder and cloacal exstrophy is a mystery. Reasons for this are the lack of human embryos showing these malformations as well as the scarcity of appropriate animal models. Here, the authors present cases of cloacal exstrophies found in chick embryos subsequent to the application of suramin and trypan blue. This animal model might facilitate insight into the embryology of cloacal exstrophy. METHODS Fertilized chicken eggs were incubated at 38 degrees C and 75% humidity. Embryos were treated in ovo on incubation day 3. The egg shell was windowed, and solutions of suramin (stage 13, 2 x 40 microL/0.2%) or trypan blue (stage 14, 2 x 80 microL/0.03%) were injected into the coelomic cavity. The window was closed, and the embryos were reincubated until examination on incubation day 8. Fifty embryos were treated in each group. RESULTS Among the surviving embryos, cloacal exstrophy was found in 2 cases in the suramin-treated group (2 of 29, 6.9%) and in 4 cases in the trypan blue-treated group (4 of 20, 20%). CONCLUSIONS Suramin and trypan blue can induce cloacal exstrophy in chick embryos. The authors now are modifying their experimental protocols to increase the incidence of this malformation. This model might facilitate studies on the morphogenesis of cloacal exstrophy.
Collapse
Affiliation(s)
- Jörg Männer
- Department of Embryology, Georg-August-University, Göttingen, Germany
| | | |
Collapse
|
25
|
Fujimura M, Kusaka Y, Shirane R. Spinal lipoma associated with terminal syringohydromyelia and a spinal arachnoid cyst in a patient with cloacal exstrophy. Childs Nerv Syst 2003; 19:254-7. [PMID: 12715194 DOI: 10.1007/s00381-002-0710-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2002] [Indexed: 10/25/2022]
Abstract
CASE REPORT A 2-year-old girl presented with repaired cloacal exstrophy and a subcutaneous mass at the midline of the lumbosacral region. Neurological examination revealed mild paraparesis with bilateral lower-extremity hyperreflexia and sensory disturbance below the level of L4. A CT scan showed asymmetrical spina bifida on the right side extending from L2 to L5, and symmetrical spina bifida below S1. Magnetic resonance imaging showed a low-set conus with terminal syringohydromyelia, lumbosacral lipoma, and the extradural arachnoid cysts at Th12-L4 compressing the spinal dural sac from behind. Surgical removal of the arachnoid cyst and lipoma relieved spinal dural sac compression and the tethered spinal cord. The patient showed an improvement in the lower-extremity hyperreflexia postoperatively. CONCLUSION The rare association of the cloacal exstrophy with the multiple spinal cord abnormalities as shown in the present case indicates that detailed routine screening of the spinal cord is necessary for the careful planning of treatment in patients with anorectal anomalies.
Collapse
Affiliation(s)
- Miki Fujimura
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, 1-1 Seiryo-machi, 980-8574 Aoba-ku, Sendai, Japan.
| | | | | |
Collapse
|
26
|
Abstract
This article describes the sonographic examination of the normal gastrointestinal tract of granivorous birds. Preliminary tests with dead birds were performed to get an idea of the sonographic echotexture of the avian gastrointestinal tract. Later, clinically healthy seedeaters of different weights were examined sonographically. As equipment a convex microcurved scanner with a particularly small coupling surface and an adjustable frequency from 5.5-7.5 MHz was used. For the investigation of the gastrointestinal tract, six sonographic approaches are described. After a starving time of 18 hours in the granivorous birds and water input, the best sonographic image quality could be obtained. Using this method, the crop, ventriculus, intestines, and cloaca could be demonstrated sonographically; whereas, it was not possible to visualize the normal proventriculus in granivorous birds. In contrast to mammals, the different layers of the wall of the gastrointestinal tract could not be visualized with the equipment used. Motility of individual parts of the gastrointestinal tract (GI tract), however, could be well demonstrated.
Collapse
|
27
|
Chen LL, Goldstein RB. Case 8. Cloacal anomaly. J Ultrasound Med 2002; 21:595-613. [PMID: 12008833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
28
|
Wilcox DT, Chitty LS. Non-visualisations of the fetal bladder: aetiology and management. Prenat Diagn 2001; 21:977-83. [PMID: 11746152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Failure to detect a normally filled fetal bladder on ultrasound scanning can imply the presence of a serious urogenital abnormality. Detailed scanning may elicit the underlying pathology, but there may be complex anomalies present, the full extent of which often has to await the results of postnatal investigations. Management in a combined paediatric urology:fetal medicine clinic is recommended.
Collapse
Affiliation(s)
- D T Wilcox
- Department of Paediatric Urology, Guys' and Great Ormond Street Hospital, London, UK
| | | |
Collapse
|
29
|
Abstract
AIM To assess the diagnostic value of spinal ultrasound in cloacal exstrophy, a caudal malformation which is associated with spinal dysraphism, and to assess the prevalence of spinal dysraphism in cloacal exstrophy. MATERIALS AND METHODS Ten infants under 1 year old with cloacal exstrophy underwent spinal ultrasound at presentation. Three patients also had a magnetic resonance imaging (MRI) examination. Ultrasound and MRI images were reviewed and correlated. RESULTS Nine of 10 patients had no external signs of spinal dysraphism. One patient had a clinically apparent myelomeningocele. Five of 10 patients (50%) had spinal dysraphism on ultrasound: there were two patients with a low cord, two with tethered cords and a lipoma, and one patient with tethering and a myelomeningocele. Thus, in four of these five patients spinal dysraphism was occult. In a small number of patients (n = 3) MRI was also performed-in these cases the MRI and ultrasound appearances correlated, however MRI was not performed in those patients in whom spinal ultrasound was normal. CONCLUSION In three cases where spinal ultrasound detected occult dysraphism and MRI was performed, spinal ultrasound and MRI correlated. Advantages of spinal ultrasound include ease of examination, production of high quality multi-planar images and the facility for portable imaging at the bedside. Spinal ultrasound should be the first investigation in all babies with cloacal exstrophy to diagnose occult and non-occult spinal dysraphism.
Collapse
Affiliation(s)
- E A Dick
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | | | | | | |
Collapse
|
30
|
Affiliation(s)
- G J Fleming
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan 66506, USA
| | | |
Collapse
|
31
|
Abstract
We describe a case of cloacal exstrophy what was diagnosed prenatally by ultrasound and confirmed at birth. We also review the literature on 15 previous prenatally diagnosed cloacal extrophy cases.
Collapse
Affiliation(s)
- H Kaya
- Department of Obstetrics and Gynecology, Süleyman Demirel Universitesi, Isparta, Turkey.
| | | | | | | |
Collapse
|
32
|
Hamada H, Takano K, Shiina H, Sakai T, Sohda S, Kubo T. New ultrasonographic criterion for the prenatal diagnosis of cloacal exstrophy: elephant trunk-like image. J Urol 1999; 162:2123-4. [PMID: 10569600 DOI: 10.1016/s0022-5347(05)68138-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Hamada
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | | | | | | | | |
Collapse
|
33
|
Zaccara A, Gatti C, Silveri M, Rivosecchi M, Bilancioni E, Spina V, Giorlandino C, De Gennaro M, Bagolan P. Persistent cloaca: are we ready for a correct prenatal diagnosis? Urology 1999; 54:367. [PMID: 10754135 DOI: 10.1016/s0090-4295(99)00135-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cloacal malformations are rare and can present in variable aspects. The importance of ultrasound in detecting these anomalies is well known. Sonographic features vary in accordance with the type of malformation and the gestational age. A positive diagnosis is not possible because of the lack of specific ultrasound findings, which can show similar aspects to other abnormalities. We present 3 cases of prenatal diagnosis of this malformation, emphasizing that in the presence of a plurilobed cystic pelvic fetal mass with associated malformations, such as cardiac, renal, and vertebral anomalies, a persistent cloaca can reasonably be suspected.
Collapse
Affiliation(s)
- A Zaccara
- Department of Paediatric Surgery, Bambino Gesu Children's Hospital, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Croce P, Nava A, Formaroli P, Dedè A. [Cloacal exstrophy, ultrasonic diagnosis]. Minerva Ginecol 1999; 51:145-8. [PMID: 10379152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This study aims to underline the importance of transvaginal ultrasonography in the first three months of pregnancy. The authors report a case which was referred to their attention for preliminary tests performed prior to amniocentesis, recommended by the general physician because of the mother's age. The primapara woman and father of the fetus were healthy and the family history excluded hereditary diseases or congenital pathologies. Transvaginal ultrasonography permitted the diagnosis at the start of the fourth month of pregnancy of a polymalformed fetus with cloacal exstrophy, sacral myelomeningocele, clubfoot, single umbilical artery. In this case, the mother decided to undergo eugenic abortion in view of the severity of the pathology.
Collapse
Affiliation(s)
- P Croce
- Divisione di Ginecologia ed Ostetricia, Civico Ospedale di Codogno
| | | | | | | |
Collapse
|
35
|
Brun M, Maugey-Laulom B, Rauch-Chabrol F, Grignon A, Diard F. [Diagnostic prenatal ultrasonography of malformations of the fetal anterior abdominal wall]. J Radiol 1998; 79:1461-8. [PMID: 9921448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abdominal wall defects include a broad spectrum of structural malformations with variable severity and prognosis. The purpose of prenatal ultrasound examination is to correctly diagnose and classify these malformations according to their localization (particularly their relation to the umbilical cord insertion), their contents, their size and associated malformations or karyotypic abnormalities. Based on this examination, two groups can be distinguished: gastroschisis or omphalocele (when the latter is isolated, in particular without karyotypic abnormalities) which can be surgically corrected at birth, and for which predictive criteria of outcome must be evaluated (vitality of herniated bowel, size and contents of omphalocele); severe malformations (ectopia cordis, cloacal exstrophy, Beckwith-Wiedemann syndrome, short umbilical cord, amniotic band syndrome) for which pregnancy termination could be proposed.
Collapse
Affiliation(s)
- M Brun
- Service de Radiologie A, Groupe Hospitalier Pellegrin-Enfants, Bordeaux, France.
| | | | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE We assess and clarify diagnostic features for making the prenatal diagnosis of cloacal exstrophy. MATERIALS AND METHODS We evaluated 9 patients born with cloacal exstrophy at our institutions (2 prospectively and 7 retrospectively) for diagnostic features on prenatal ultrasound studies. We also thoroughly reviewed the literature on 13 previous prenatally diagnosed cloacal exstrophy cases. Diagnostic criteria were assessed by combining the findings in our patients and those in previous reports. RESULTS Of the 22 patients with prenatal ultrasound studies and cloacal exstrophy whom we analyzed 1 of our 9 and 2 in the literature had a cloacal membrane that persisted at 22 weeks of gestation. Major ultrasound criteria for diagnosing cloacal exstrophy prenatally are nonvisualization of the bladder, a large midline infraumbilical anterior wall defect or cystic anterior wall structure (persistent cloacal membrane), omphalocele and lumbosacral anomalies. Seven less frequent or minor criteria include lower extremity defects, renal anomalies, ascites, widened pubic arches, a narrow thorax, hydrocephalus and 1 umbilical artery. CONCLUSIONS We propose major and minor criteria to assist in the prenatal diagnosis of cloacal exstrophy. Despite these major and minor criteria the certainty of establishing a prenatal diagnosis remains challenging. Persistence of the cloacal membrane beyond the first trimester in 1 patient was an exception to the classic concept of cloacal exstrophy embryogenesis. An accurate prenatal diagnosis requires validation of these criteria by further correlation of prenatal and postnatal observations.
Collapse
Affiliation(s)
- P F Austin
- Department of Obstetrics, University of South Florida, Tampa, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Cacciaguerra S, Lo Presti L, Di Leo L, Grasso S, Gangarossa S, Di Benedetto V, Di Benedetto A. Prenatal diagnosis of cloacal anomaly. Scand J Urol Nephrol 1998; 32:77-80. [PMID: 9561584 DOI: 10.1080/003655998750014783] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors present a case of prenatal diagnosis of cloacal anomaly, characterized by the presence of oligohydramnios and cystic pelvic mass with changing features during observation. Postnatal study confirmed the presence of a recto-cloacal fistula, with a high confluence of the urinary, genital and intestinal systems. Both parents had a chromosome 9 inversion (p11q13), but the child was chromosomally normal.
Collapse
Affiliation(s)
- S Cacciaguerra
- Cattedra di Chirurgia Pediatrica, Università di Catania, Italy
| | | | | | | | | | | | | |
Collapse
|
38
|
Girz BA, Sherer DM, Atkin J, Venanzi M, Ahlborn L, Cestone L. First-trimester prenatal sonographic findings associated with OEIS (omphalocele-exstrophy-imperforate anus-spinal defects) complex: a case and review of the literature. Am J Perinatol 1998; 15:15-7. [PMID: 9475681 DOI: 10.1055/s-2007-993891] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
First-trimester sonographic findings associated with omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex and review of the literature regarding this rare congenital anomaly are presented.
Collapse
Affiliation(s)
- B A Girz
- The Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, New York 10461, USA
| | | | | | | | | | | |
Collapse
|
39
|
Odibo AO, Turner GW, Borgida AF, Rodis JF, Campbell WA. Late prenatal ultrasound features of hydrometrocolpos secondary to cloacal anomaly: case reports and review of the literature. Ultrasound Obstet Gynecol 1997; 9:419-421. [PMID: 9239829 DOI: 10.1046/j.1469-0705.1997.09060419.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cloacal anomalies are extremely rare and have variable presentations. Prenatal diagnosis can be difficult especially if they present in late gestation. Here we present two cases diagnosed in the late third trimester and review the literature regarding prenatal diagnosis of cloacal anomalies.
Collapse
Affiliation(s)
- A O Odibo
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06030-2950, USA
| | | | | | | | | |
Collapse
|
40
|
Pinette MG, Pan YQ, Pinette SG, Stubblefield PG, Blackstone J. Prenatal diagnosis of fetal bladder and cloacal exstrophy by ultrasound. A report of three cases. J Reprod Med 1996; 41:132-4. [PMID: 8656415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bladder and cloacal exstrophy can be diagnosed with prenatal ultrasound. CASES Three cases of bladder and cloacal exstrophy were diagnosed prenatally by ultrasound and confirmed at birth. The ultrasound findings were a soft tissue mass in the lower abdominal wall (which appeared larger and more heterogeneous in cloacal exstrophy than in bladder exstrophy), absent bladder, malformation of the external genitalia and normal kidneys along with normal amniotic fluid volume. CONCLUSION Prenatal diagnosis of these defects will allow appropriate referrals prior to birth.
Collapse
Affiliation(s)
- M G Pinette
- Department of Obstetrics and Gynecology, Maine Medical Center, Scarborough 04074, USA
| | | | | | | | | |
Collapse
|
41
|
Abstract
The motility of the lower gastrointestinal (GI) tract of white leghorn roosters was observed by radiographic methods. Intracolonic pressure changes were recorded, and the mechanical activity of the colon was quantified using strain gauges that were attached to the serosa. Two types of retrograde contraction waves were observed: small fast peristaltic contractions (15 min-1) and large slow contractions. The small fast contractions are the actual vehicle of the retrograde movement, but they seemed to be linked to respiratory movements in the fashion of coupled oscillators during most of their activity time (94%). This makes them an unlikely target for regulation. The large slow waves (3 min-1) probably reflect contractions of the longitudinal musculature. They are retrograde and may permit or modulate the refluxing of urine. The effects of water deprivation, intravenous volume, and salt loads on colonic motility were analyzed. All manipulations that increased urine flow rates without changing urine osmolality resulted in increased propagation speed of the large contraction waves. All manipulations that increased urine osmolality resulted in decreases in activity time of the large-wave pattern. These results suggest a hydration state-related control of the retrograde colonic motility in birds. Direct stimulation of central osmoreceptors had no such effects, indicating that local volume and osmolality receptors of the cloaca are more important than central receptors for this adjustment of colonic motility.
Collapse
Affiliation(s)
- M Brummermann
- Department of Physiology, University of Arizona, Tucson 85724
| | | |
Collapse
|
42
|
Sepulveda W, Romero R, Qureshi F, Greb AE, Cotton DB. Prenatal diagnosis of enterolithiasis: a sign of fetal large bowel obstruction. J Ultrasound Med 1994; 13:581-585. [PMID: 7933024 DOI: 10.7863/jum.1994.13.7.581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- W Sepulveda
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Hospital, Detroit, Michigan
| | | | | | | | | |
Collapse
|
43
|
Abstract
Cloacal malformation is a rare abnormality, occurring only in females and characterized by a direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report 2 cases of prenatal diagnosis of this condition with a varied ultrasonic appearance including fetal ascites, cystic retrovesical mass, ambiguous genitalia, nonvisualization of the bladder, and oligohydramnios.
Collapse
Affiliation(s)
- B G Cilento
- Department of Surgery, Children's Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
44
|
Chitrit Y, Zorn B, Filidori M, Robert E, Chasseray JE. Cloacal exstrophy in monozygotic twins detected through antenatal ultrasound scanning. J Clin Ultrasound 1993; 21:339-342. [PMID: 8514902 DOI: 10.1002/jcu.1870210509] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- Y Chitrit
- Department of Gynecology and Obstetrics, Centre Hospitalier Robert Ballanger, Aulnay Sous Bois, France
| | | | | | | | | |
Collapse
|
45
|
Abstract
Female omphalopagus conjoined twins were successfully delivered vaginally and required emergency surgical separation shortly after birth for gastroschisis. Shared tissue included conjoined bowel; one twin also had a complex cloacal abnormality and patent urachus. A 2-year follow-up is presented. A review of the relevant literature confirms that this is the first example of gastroschisis conjoining omphalopagus twins.
Collapse
Affiliation(s)
- J M Walton
- Department of Surgery, IWK Children's Hospital, Halifax, Nova Scotia, Canada
| | | | | | | | | |
Collapse
|
46
|
Abstract
The sonograms of five neonates with an obstructed urogenital sinus and four with an obstructed cloaca were retrospectively reviewed to determine the sonographic features and the role of pre- and postnatal sonography in the diagnosis and management of hydrocolpos. On pre- and/or postnatal sonograms, the obstructed genital tract was visualized in seven neonates as a large cystic pelvic-abdominal mass, which was the markedly distended urine-filled vagina. One neonate had multiple cystic masses, which resulted from an obstructed duplex genital tract. In one of the neonates with an obstructed cloaca, the anomaly was not diagnosed. The bladder was compressed by the distended vagina and was not visualized in five patients. A vaginal fluid-debris level in six patients was a key finding that distinguished the vagina from the bladder. Obstruction of the urinary tract was an associated feature. An obstructed uterovaginal anomaly with renal dysplasia and oligohydramnios on prenatal sonograms indicates a poor prognosis. Sonography contributes to the diagnosis of an obstructed genital tract and helps define the internal genital anatomy.
Collapse
Affiliation(s)
- A R Blask
- Department of Radiology, Johns Hopkins Hospital, Baltimore
| | | | | |
Collapse
|
47
|
Abstract
The imaging studies and records of 65 patients with the cloacal malformation seen from 1969 to 1989 were reviewed. The malformations were described according to cloacal configuration (urethral, vaginal), type of urinary-cloacal communication (urethral, vesical), and level of rectal communication (vaginal, cloacal, vesical, other). Lower urinary tract abnormalities were frequent (reflux, ureteral ectopia, bladder diverticula, bladder duplication, urachal remnants, urethral duplication), as were genital abnormalities (uterine duplication, vaginal duplication, uterine atresia, vaginal atresia), abnormalities of the bony pelvis (partial sacral agenesis, pubic diastasis), and renal abnormalities (agenesis, obstruction, horseshoe kidney). Contrast material studies of the cloaca and the distal limb of the colostomy with fluoroscopy in various projections were essential for diagnosis. Voiding cystourethrography was important for detecting vesicoureteric reflux. Sonography was of limited value for evaluation of the malformation but was valuable for imaging the kidneys. MR imaging revealed that spinal cord abnormalities cannot be predicted based on the appearance of the lumbosacral spine and are more common than previously thought.
Collapse
Affiliation(s)
- D Jaramillo
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA 02115
| | | | | |
Collapse
|
48
|
Abstract
The radiographs of 28 patients with bladder exstrophy and five with cloacal exstrophy were reviewed at an average age of 8 years 3 months to assess congenital vertebral malformations. Fourteen malformations in 11 patients were noted, including abnormal lumbosacral segmentation in five, congenital scoliosis and kyphosis in four, partial sacral agenesis in three, and interpedicular lumbar widenings in two. These findings are explained by an abnormal embryologic development of the spine and cloaca between 4 and 6 weeks of intrauterine life. We recommend entire spinal radiographs in these patients.
Collapse
Affiliation(s)
- R T Loder
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | |
Collapse
|
49
|
Cheng GK, Fisher JH, O'Hare KH, Retik AB, Darling DB. Anomaly of the persistent cloaca in female infants. Am J Roentgenol Radium Ther Nucl Med 1974; 120:413-23. [PMID: 4814225 DOI: 10.2214/ajr.120.2.413] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
50
|
|