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[Hydrocolpos and hydrometrocolpos in newborns.]

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Abstract

Hydrocolpos and the hydrometrocolpos are anomalies resulting from vaginal and uterine retention and accumulation of cervicovaginal secretions caused by congenital malformation. It is a rare pathology affecting the female newborn and infant and much less often young girls. It appears clinically as an abdominal mass associated with absence or abnormality of the vaginal opening. The diagnosis is confirmed by abdominal echography and CT scan. Treatment varies from the simple X-shaped hymenotomy for the isolated imperforate hymen to major surgery for substantial retentions and complex urogenital abnormalities. The authors report two cases of hydrocolpos and hydrometrocolpos discovered in the neonatal period. These were two newborn babies resulting from poorly followed pregnancies at which the clinical examination noted in both cases a large abdominal mass. The physical examination, imagery and surgical exploration demonstrated the existence of enormous hydrocolpos with imperforate hymen in 1 case and hydrometrocolpos with distal vaginal atresia in the second case. The treatment consisted of draining the secretions for both patients, after an X-shaped hymenotomy for the first and after section anastomosis of the vaginal atresia for the second. Both cases progressed favorably. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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... Urinary tract obstruction can lead to oligohydramnios antenatally. Sepsis leading to death can occur secondary to either urinary tract infection or rupture and secondary peritonitis [1,2]. ...
... It occurs secondary to a combination of stimulated secretions as well as distal vaginal obstruction [1]. The causes of retention of cervico-vaginal secretions are varied and include imperforate hymen, transverse vaginal septum, abnormal vaginal opening, vaginal atresia and malformations of cloaca including urogenital sinus [2]. ...
Article
A three-day-old female child presented to us with abdominal distension and lower limb swelling. On ultrasound examination, there was a cystic mass contiguous with the uterus in the lower abdomen and pelvis which showed fluid-debris level. This mass was causing displacement of the urinary bladder anteriorly. MRI confirmed the findings of ultrasound. A diagnosis of hydrometrocolpos secondary to imperforate hymen was made following physical examination. Neonatal hydrometrocolpos is a rare condition which requires a high index of suspicion for diagnosis. Hydrometrocolpos refers to the accumulation of secretions within the endometrial and endovaginal canal. Diagnosis can be made prenatally or post natally using ultrasonography and magnetic resonance imaging. Early diagnosis reduces the incidence of complications. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.
... Hydrocolpos is usually encountered either in the newborn and/or neonatal period, secondary to stimulation from residual mother's hormones, or at menarche, during estrogen surge [4] . The occurrence beyond infancy and before puberty, is somehow rare, mainly due to inadequate uterine and vaginal secretions during this period [5] . ...
... The occurrence beyond infancy and before puberty, is somehow rare, mainly due to inadequate uterine and vaginal secretions during this period [5] . As such, there is a bimodal age distribution for developing hydrocolpos and secondary pyocolpos [4] . The high levels of maternal hormones during the neonatal period and the hormonal surge during puberty, would increase vaginal gland secretions, and in the presence of distal obstruction, can lead to hydrocolpos or hydrometrocolpos. ...
Article
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Thorough physical examination is a must for proper diagnosis of medical diseases and to elucidate all physical findings. Abdominal pain is a very common presentation to Emergency Department, compromising 5%-10% of all visits, and around a quarter are discharged with no particular diagnosis. Pyocolpos is one of those presentations that requires a thorough physical examination, including that of the external genitalia. A 3-year-old girl presented with recurrent history of abdominal pain and a recent history of fever with acute abdomen picture-like presentation, with difficulty voiding over the past few days. She was previously assessed for recurrent abdominal pain, without any identifiable etiology. Upon inspection for indwelling catheter insertion, absence of the vaginal introitus was noted with a bulging mass and an imperforate hymen. Pyocolpos was diagnosed and drained following hymenotomy. Pyocolpos is a rare complication of hydrocolpos. Enlarged vagina causes extrinsic compression to nearby structures, such as the bladder trigone and ureters, causing hydronephrosis, hydroureter, and other sequel including acute kidney injury and urosepsis. An imperforate hymen must be considered in the differential for chronic and recurrent abdominal pain, and can be easily identified by a thorough physical examination, including that of the external genitalia, which is a must in today's every medical practice.
... [1] The causes of vaginal obstruction include imperforate hymen, transverse vaginal septum, abnormal vaginal opening, vaginal atresia, and malformations such as failure of recanalization of cloaca and urogenital sinus. [2,3] There may be associated uterine or Müllerian duct anomalies and isolated anomalies of the digits such as polydactyl. Other associations include tracheoesophageal fistula, anorectal, vertebral and cardiac anomalies as well as syndromic anomalies such as VACTERL association (vertebral, anal, cardiovascular, tracheoesophageal, renal, and limb anomalies), MURCS association (Müllerian duct aplasia/hypoplasia, renal agenesis/ectopia, and cervicothoracic somite dysgenesis such as Klippel-Feil abnormality, anomalous ribs, or Sprengel deformity), and mesodermal anomalies such as McKusick-Kaufman syndrome, an autosomal recessive disorder which includes vaginal atresia and secondary HMC, hexadactyly, congenital cardiac anomalies, and hydrops fetalis. ...
Article
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Hydrometrocolpos (HMC) is a rare clinical condition resulting in accumulation of fluid in the endometrial and vaginal cavities secondary to vaginal obstruction. Vaginal obstruction can be caused by imperforate hymen, transverse vaginal septum, vaginal atresia, abnormal vaginal opening, and malformation of the urogenital sinus. Imperforate hymen is the most common cause. Time of presentation can be from the neonatal period to mid-adolescent age and can present as an isolated case or part of a syndrome. The usual clinical symptom is suprapubic abdominal mass. Symptoms from mass effect on surrounding organs, such as urinary retention and constipation, as well as complications of chronic fluid accumulation, such as tuboovarian abscess can be the initial presentation. With a high index of suspicion, diagnosis can be made with adequate clinical history, examination, and imaging. HMC should be considered in female neonates and infants presenting with midline suprapubic intra-abdominal mass irrespective of other clinical presentations.
... Associated anomalies are commonly seen with vaginal atresia, urogenital sinus or cloacal malformations. 3 It may also be associated with the McKusick-Kaufman syndrome, an autosomal recessive disorder characterized by vaginal atresia with hydrometrocolpos, polydactyly, congenital heart defects, and imperforate anus. 4 Presentation usually depends on the amount of collection and extent of compression on surrounding structures. ...
... The management is simple with low type I and II anomalies and drainage procedures alone may be curative [6,39,42,75]. A bulging membrane in an infant with imperforate hymen or transverse septum of the vagina may be incised (hymenotomy) or excised (hymenectomy) (Fig. 3). ...
Article
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Hydrometrocolpos is a rare condition in which the uterus and the vagina are grossly distended with a retained fluid other than pus or blood. It may present during the neonatal period or later at puberty. Most cases reported earlier were stillbirths and were diagnosed only on autopsy. Antenatal diagnosis is now possible with the advent of ultrasound. An early diagnosis and speedy management is the key to survival. Many previous case reports have focused on the varied clinical presentations, multiple causes, associated syndromes and/or the radiological diagnosis of this condition. However, management options for different types of hydrometrocolpos have not yet been concisely discussed. We have reviewed the literature and tried to summarize the management options applicable to most case scenarios of hydrometrocolpos.
... Pyometrocolpos is defined as an infection of fluid within the vagina and uterus. It can occur as a result of an accumulation of cervicovaginal secretions due to congenital malformations including distal genital tract obstruction, imperforate hymen, or genitourinary sinus [1,2]. Patients may present in infancy, adolescence, or even as adults. ...
Article
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Pyometrocolpos can be caused by congenital malformations such as distal vaginal atresia and imperforate hymen. Patients usually present with obstructive urinary tract infections, acute kidney injury, or sepsis. Percutaneous drainage of the infected fluid can help treat the patient; however, recurrence is of concern. In this case report, we present a case of a child with recurrent pyometrocolpos due to distal vaginal atresia despite initial percutaneous drainage. To our knowledge, this is the first report of ultrasound-guided introital drainage of pyometrocolpos with relief of symptoms obviating the need for repeat drainage or immediate surgery.
... 12,13 Postnatally diagnosis of HMC is confirmed by ultrasound abdomen echography and CT scan. 14 The definitive treatment involves drainage of the accumulated fluid in the uterine cavity and establishing communication between the vaginal epithelium and the vulva. In the cases of HMC secondary to imperforate hymen and low vaginal atresia, perineal approach is preferable. ...
Article
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Neonatal hydrometrocolpos (HMC) is a rare Mullerian duct anomaly with an incidence of 0.006%. It occurs due to blockage of the vagina with accumulation of mucus secretions proximal to the obstacle. These secretions are secondary to intrauterine and postnatal stimulation of uterine and cervical glands by maternal estrogens. A triad of congenital HMC, polydactyly, and cardiac anomalies are the cardinal features of McKusick-Kaufman syndrome, which is also known as hydrometrocolpos-polydactyly syndrome. Bardet-Biedl syndrome is a well-known combination of hypogonadism, obesity, postaxial polydactyly, renal dysplasia, retinal degeneration, and mental impairment. In this case report, we describe a neonate with HMC, polydactyly, and hydronephrosis.
Article
Full-text available
Persistent urogenital sinus (PUGS) is a congenital pathological condition characterized by an abnormal communication between the urethra and vagina, which has an estimated incidence of 0.6/10,000 female births. It could be the only known malformation or part of a syndrome. PUGS is commonly shown by a pelvic mass, related to a distended bladder, hydrometrocolpos which is due to an obstruction leading to the dilation of the vagina and uterus (i.e., imperforate hymen, transverse vaginal septum or atresia, and PUGS) or both. We present a case of female patient with classical congenital adrenal hyperplasia, diagnosed on the 7th day of life, with ambiguous genitalia, untreated surgically only with hormone therapy by parental decision. The patient, at the age of 5 years and 5 months, came to our observation for a pelvic ultrasound, which revealed retrovesical neoformation with anechoic content and regular walls. We performed the ultrasound examination that showed the dilation of the cervix and the vaginal canal with anechoic finely corpuscolated content in the declining portion, compatible with hydrometrocolpos from probable persistence of the urogenital sinus. The voiding cystourethrography (VCUG) confirmed the ultrasound diagnosis, with evidence of urogenital sinus. In conclusion, ultrasound is the first diagnostic tool, but need to be completed by other technical procedures, which VCUG or magnetic resonance imaging to observe the site of fusion of the urinary and genital tract.
Article
Background: Imperforate hymen prevents menstrual blood drainage, which causes cyclic lower abdominal pain and amenorrhea. Untreated cases may develop serious complications as endometriosis and infertility. Hymenectomy represents the adequate treatment. Case: A16 years old virgin female with recurrent lower abdominal pain, urine retention and secondary amenorrhea following three hymenectomy operations, examination revealed imperforate hymen. A fourth hymenectomy operation was performed with continuous locked sutures all over the edges. Summary and conclusion: Reformed imperforate hymen after hymenectomy should be suspected if the symptoms recurred. Diagnosis can be achieved through meticulous clinical examination and appropriate imaging techniques.
Article
Résumé L’imperforation de l’hymen est la malformation congénitale la plus fréquente de l’appareil génital féminin et reste généralement asymptomatique jusqu’à la puberté. Le diagnostic de cette malformation est rarement fait à la naissance et le traitement est l’hyménéotomie, souvent chirurgicale. La rupture spontanée de l’hymen imperforé est possible mais rare. Nous rapportons deux cas d’imperforation de l’hymen révélée par un mucocolpos à la naissance. L’échographie abdominopelvienne n’avait pas objectivé d’hydrocolpos ou d’hydrométrocolpos. Une rupture spontanée de l’hymen imperforé a été observée respectivement au 4e et 7e jour de vie avec un résultat satisfaisant à l’âge d’un mois. Le dépistage de l’imperforation de l’hymen doit être systématique à la naissance afin de proposer une hyménéotomie précoce en l’absence d’une rupture spontanée adéquate et éviter les complications graves de cette affection à la puberté.
Article
Neonatal hydrometrocolpos (HMC) is a rare Mullerian duct anomaly with an incidence of 0.006%. It occurs due to blockage of the vagina with accumulation of mucus secretions proximal to the obstacle. These secretions are secondary to intrauterine and postnatal stimulation of uterine and cervical glands by maternal estrogens. A triad of congenital HMC, polydactyly, and cardiac anomalies are the cardinal features of McKusick–Kaufman syndrome, which is also known as hydrometrocolpos-polydactyly syndrome. Bardet–Biedl syndrome is a well-known combination of hypogonadism, obesity, postaxial polydactyly, renal dysplasia, retinal degeneration, and mental impairment. In this case report, we describe a neonate with HMC, polydactyly, and hydronephrosis.
Article
Hydrocolpos is characterized by a vaginal accumulation of cervical and vaginal secretions. It often occurs in newborn child and infant. Imperforate hymen is frequently associated; in rare instances, complete higher vaginal diaphragm or partial vaginal atresia is diagnosed. Hydrocolpos can be treated by hymenectomy using imperforate hymen. Because of additional malformation, the treatment can be more complex for vaginal obstruction. The authors report a series of four patients with hydrocolpos: three neonates and one 2-month old infant. Ultrasonography confirmed the physical findings. Three patients with imperforate hymen underwent hymenectomy in X. The fourth which had a virginal atresia and pyocolpos drainage was treated using celioscopy. The three first patients outcome was favorable except for the patient with pyocolpos who died with septicemia.
Article
Introduction A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management. Case report An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400 cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later. Conclusion In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.
Article
Urinary incontinence in pediatric and adolescent patients has been successfully managed with the artificial urinary sphincter for several decades. Placement of the sphincter can be difficult in the preadolescent girl due to poorly developed vaginal tissue that can result in difficulty establishing the surgical plane between the bladder and vagina. We report 2 patients in whom the sphincter was placed around the urethra and vagina, a complication that has been reported in only 1 patient previously. All 3 patients presented with hematometrocolpos and bloody vaginal discharge. All were successfully managed with replacement of the sphincter cuff around the urethra and delayed vaginoplasty.
Article
We report on a case of duplicated hydrometrocolpos with uterus didelphys, a septate vagina, lower vaginal atresia, a persistent urogenital sinus, left ear agenesis, a single umbilical artery, and an imperforate anus, but without the associated features of McKusick–Kaufman syndrome such as polydactyly and congenital heart defects. Ultrasound-guided fluid aspiration of the fetal intrapelvic cystic mass helped to decompress the distended genital organs, decrease the severity of the urinary tract obstruction, delineate the ultrasonographic image of duplicated hydrometrocolpos to differentiate it from other intrapelvic cystic masses, and obtain fluid for cytological analysis.
Article
A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management. An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later. In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.
Article
Meconium peritonitis results from intestinal wall perforation with meconium spillage into the peritoneum during intrauterine life. Anal atresia is associated with meconium peritonitis and is also associated with cloacal malformation. A female neonate presented with a distended abdomen, anal atresia, and meconium peritonitis as diagnosed by calcification in the peritoneal cavity on abdominal radiograph. Sonography and cystography demonstrated a cloacal malformation with perforation of the hydrocolpos and resultant spillage of meconium into the peritoneum. There was no evidence of further perforation of bowel at surgery. This unusual case of meconium peritonitis is reported.
Article
Serial sonographic findings are presented in three cases of cloacal anomalies. The following sonographic signs were noted: transient fetal ascites, bicystic intra-abdominal structure arising from the fetal pelvis, and oligohydramnios and impaired interval growth. This sequence of sonographic findings may help clarify the natural history of the developing cloacal anomaly: In the early state of its formation, urine enters the abdominal cavity via the fallopian tubes, causing ascites; later, chronic urinary and meconium irritation of tubal mucosa may cause tubal obstruction, which in turn may lead to the formation of genitourinary tract distention, hydronephrosis, and oligohydramnios. Timely diagnosis of cloacal anomalies improves the outcome of pregnancies (delivery in the tertiary care center, early operative correction).
Article
Congenital imperforate hymen is an external urogenital anomaly that has a small differential diagnosis. With careful antenatal sonographic evaluation of the female perineum, identification of a thin protruding membrane consistent with imperforate hymen can be made. We report a case in which an imperforate hymen was diagnosed in a fetus at 25 weeks' gestation. It appeared as a thin membrane that distended the vagina and spread the labia majora because of retained secretions. An associated renal abnormality was present, representing either a right multicystic dysplastic kidney or cystic dysplasia. Imperforate hymen and hydrocolpos can be diagnosed as early as the second trimester. Because of the additional renal anomaly in this case, it is suggested that the presence of prenatally diagnosed imperforate hymen warrants a careful survey of the remaining fetal anatomy to rule out associated abnormalities. The possibility of a familial occurrence should be considered, and the appropriate history should be obtained.
Article
To analyze the etiologies and outcomes for a southeastern section of the United States, and to organize an efficient approach to evaluation. We reviewed 82 cases of non-immune hydrops presenting after 20 weeks' gestation over a 10-year period. Overall perinatal mortality was 86.6%. Fetuses diagnosed with hydrops before 24 weeks' gestation had a perinatal mortality of 95%, with nearly one-third having abnormal karyotypes. The etiology of hydrops diagnosed after 24 weeks' gestation was more likely to remain idiopathic or to be related to cardiothoracic abnormalities. Before 24 weeks' gestation, the high risk of mortality and abnormal karyotype justifies offering families funipuncture in the hope of finding a treatable cause of non-immune hydrops. After 24 weeks' gestation, when fewer abnormal karyotypes are found, funipuncture may also be pivotal in diagnosing the cause of non-immune hydrops.
The diagnostic circumstances, clinical features and complementary explorations in hematocolpos are discussed. Hematocolpos due to imperforate hymen is treated by simple star incision protecting the Bartholin gland orifices to separate the hymen and the meatus. Hematocolpos resulting from duplex uterus with a blind hemivagina is more difficult to treat. Systematic screening at birth and treatment during infancy is proposed to prevent the development of hematocolpos at puberty.
Article
Cloacal anomalies are rare abnormalities with highly variable forms, which makes them difficult to diagnose antenatally. We present a cloacal anomaly case with interesting antenatal ultrasonographic findings. A 24-year-old woman, gravida 1, para 0, presented at 23 weeks' gestation with ultrasonographic evidence of fetal ascites. Between 23 and 30 weeks' gestation, serial ultrasounds showed changing features of a cloacal anomaly, consisting of fetal ascites, a cystic pelvic mass, hydronephrosis, and oligohydramnios. Serial antenatal ultrasound helped diagnose changing features of a cloacal anomaly in our case, thus allowing directed antenatal counseling and appropriate perinatal treatment.
Article
1. 1. Congenital hydrocolpos is caused by a combination of vaginal obstruction and fetal cervical gland secretion caused by stimulus of the maternal hormones. 2. 2. The vaginal obstruction may be caused by atresia, imperforate hymen, or possibly by a congenital fold of tissue which causes a valvelike obstruction in a partially stenotic vagina. 3. 3. The most important factor in treatment of this anomaly is the establishment of a correct preoperative diagnosis. 4. 4. When the correct diagnosis is made, most of these patients will be cured by a relatively simple transperineal drainage procedure. 5. 5. Long-term follow-up is essential since the distended, hypertrophic vagina and the associated hydronephrosis tend to develop intercurrent infection during their slow return to normal.
Article
Cloaca is defined as a defect in which the urinary tract, the vagina and the rectum are fused, creating a single common channel, and opening into an orifice at the site of the normal urethra. Correct management includes an early diagnosis and adequate treatment from the newborn period. We believe that these patients are frequently misdiagnosed and consequently mistreated. The analysis of our experience with the treatment of 330 cases allowed us to make specific recommendations to improve the management of these patients. During the first 24 h of life, emphasis is placed on the recognition and treatment of potentially lethal associated defects, mainly urologic, oesophageal or cardiac. The baby should not be taken to the operating room without ruling out these associated defects. The basic principles of the main repair are delineated. Patients suffering from cloacas with common channels shorter than 3 cm can be treated by a general paediatric surgeon, provided he or she is familiar with the procedure and observes a delicate and meticulous technique. Patients suffering from cloacas with common channels longer than 3 cm belong, by definition, to a more complex type of deformity that, in order to be repaired, requires a surgeon with more experience as well as knowledge of paediatric urology. Sixty percent of all our patients enjoy voluntary bowel movements (VBM). Seventy percent of all patients with a common channel longer than 3 cm require intermittent catheterization to empty their bladder, whereas 20% of those born with a common channel shorter than 3 cm require such a manoeuvre. All patients must be followed on a long-term basis in order to evaluate sexual function and care for obstetric issues.
Article
Hydrocolpos is the accumulation of blood behind an imperforate hymen. Patients often present in early adolescence with cyclic abdominal pain. We present the case of an elite gymnast who, after 6 months of symptoms and a series of incorrect diagnoses, was diagnosed with hydrocolpos. It is likely that the patient's extraordinary training regimen contributed to the difficulty in diagnosis.
Article
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. 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. 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. 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.
Article
The aim of this study was to describe lessons learned from the authors' series of patients with cloaca and convey the improved understanding and surgical treatment of the condition's wide spectrum of complexity. The medical records of 339 patients with cloaca operated on by the authors were retrospectively reviewed. A total of 265 patients underwent primary operations, and 74 were secondary. All patients were approached posterior sagittally; 111 of them also required a laparotomy. The average length of the common channel was 4.7 cm for patients that required a laparotomy and 2.3 cm for those that did not. Vaginal reconstruction involved a vaginal pull-through in 196 patients, a vaginal flap in 38, vaginal switch in 30, and vaginal replacement in 75 (36 with rectum, 31 with ileum, and 8 with colon). One hundred twenty-two patients underwent a total urogenital mobilization. Complications included vaginal stricture or atresia in 17, urethral strictures in 6, and urethro-vaginal fistula in 19, all of which occurred before the introduction of the total urogenital mobilization. A total of 54% of all evaluated patients were continent of urine and 24% remain dry with intermittent catheterization through their native urethra and 22% through a Mitrofanoff-type of conduit. Seventy-eight percent of the patients with a common channel longer than 3 cm require intermittent catheterization compared with 28% when their common channel was shorter than 3 cm. Sixty percent of all cases have voluntary bowel movements (28% of them never soiled, and 72% soiled occasionally). Forty percent are fecally incontinent but remain clean when subjected to a bowel management program. Forty-eight patients born at other institutions with hydrocolpos were not treated correctly during the neonatal period. The surgeons failed to drain the dilated vaginas, which interfered with the drainage of the ureters and provoked urinary tract infections, pyocolpos, and/or vaginal perforation. In 24 patients, the colostomy was created too distally, and it interfered with the pull-through. Twenty-three patients suffered from colostomy prolapse. All of these patients required a colostomy, revision before the main repair. Thirty-six patients underwent reoperation because they had a persistent urogenital sinus after an operation done at another institution, and 38 patients underwent reoperation because they suffered from atresia or stenosis of the vagina or urethra. The series was divided into 2 distinct groups of patients: group A were those with a common channel shorter than 3 cm (62%) and group B had a common channel longer than 3 cm (38%). The separation of these groups has important therapeutic and prognostic implications. Group A patients can be repaired posterior sagittally with a reproducible, relatively short operation. Because they represent the majority of patients, we believe that most well-trained pediatric surgeons can repair these type of malformations, and the prognosis is good. Group B patients (those with a common channel longer than 3 cm), usually require a laparotomy and have a much higher incidence of associated urologic problems. The surgeons who repair these malformations require special training in urology, and the operations are prolonged, technically demanding, and the functional results are not as good as in group A. It is extremely important to establish an accurate neonatal diagnosis, drain the hydrocolpos when present, and create an adequate, totally diverting colostomy, leaving enough distal colon available for the pull-through and fixing the colon to avoid prolapse. A correct diagnosis will allow the surgeon to repair the entire defect and avoid a persistent urogenital sinus. Cloacas comprise a spectrum of defects requiring a complex array of surgical decisions. The length of the common channel is an important determinant of the potential for urinary control, and predicts the extent of surgical repair.