Cloacal malformation, previously called persistent cloaca, is found in female children where the rectum, vagina and urethra are fused together, creating a single common channel. Typically, these are three separate openings. Cloacal malformations are rare, affecting one out of every 20,000 to 25,000 newborn girls. What causes cloacal malformation is not known. This condition occurs randomly but is the subject of ongoing research at Nationwide Children’s Hospital between CCPR and the Steve and Cindy Rasmussen Institute for Genomic Medicine.
A cloacal anomaly can cause problems with the kidneys, gynecologic organs and/or spinal cord. It can also cause hydrocolpos, a condition that causes fluid to back up in the vagina and uterus.
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Cloacal malformation reconstructive surgery requires a collaborative effort by experienced pediatric surgeons with colorectal experience, pediatric urologists, gynecologists and other specialists. Care from multiple specialties is important because malformations affect the urinary, gynecologic and gastrointestinal tracts. At Nationwide Children’s, all three subspecialties are involved from the beginning. The goal of surgery is to help the child gain urinary and bowel control, and to be able to function sexually later in life.
The extent of the cloacal malformation or abnormality is determined with imaging tools like special X-rays and ultrasounds. Treatment is based on how long the single channel and urethra is and how well the bladder continence mechanism had developed.
Colostomy
Often, children will require a colostomy at just a few days old so that stool can exit their body.
Vaginal Reconstruction
Surgery such as a vaginal reconstruction to create separate openings usually takes place between 6 and 12 months of age.
PSARVUP for Cloacal Malformation
During normal development, the cloaca should divide into three areas: the bladder, genitalia and rectum. When this does not occur, it must be corrected by a surgery called posterior sagittal anorectal vaginal urethralplasty (PSARVUP). The surgical team usually performs PSARVUP when the baby is between 6 and 12 months old.
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From infancy through adulthood, our expert team of colorectal surgeons, urologists, gynecologists, gastroenterologists, psychologists and child life specialists, is prepared to care for your child throughout their journey. The team is led by Richard Wood, MD, an internationally recognized pediatric surgeon who has performed hundreds of colorectal and pelvic reconstructions. He works very closely with our gynecology team, led by Geri D. Hewitt, MD, and the urology team, led by Daniel Dajusta, MD.
Richard J. Wood
Richard J. Wood, MD, is the Chief of the Section of Pediatric Colorectal & Pelvic Reconstructive Surgery at Nationwide Children’s Hospital, Director of the Center for Colorectal & Pelvic Reconstruction and associate professor of Pediatric Surgery at The Ohio State University.
Geri D. Hewitt
Geri. D. Hewitt, MD, is Chief of the Section of Obstetrics and Gynecology at Nationwide Children’s Hospital and a Professor of Clinical Obstetrics in the Departments of Obstetrics and Gynecology at The Ohio State University College of Medicine.
Daniel G. DaJusta
Daniel G. DaJusta, MD, s a surgeon in the Section of Urology and the Director of Urologic Surgery for the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital.
Desalegn T. Yacob
Desale Yacob, MD, is an attending pediatric gastroenterologist, Medical Director of the Motility Center and Director of Gastroenterology and Motility for the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital.
Venkata R. Jayanthi
Venkata R. Jayanthi, MD, is Chief of the Section of Pediatric Urology at Nationwide Children’s Hospital and a Clinical Professor of Surgery in the Department of Urology at The Ohio State University College of Medicine.
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Care for Every Stage
Colorectal and pelvic conditions like cloacal malformation are complex. That’s why we offer resources beyond the treatment plan – to help patients live a full life, no matter their age or stage of their condition.
Because cloacal malformation is present at birth, many adult providers are unfamiliar with the medical and surgical care required for these patients. Alessandra Gasior, MD, is the first surgeon to have completed a fellowship in both pediatric and adult colorectal care. She started the Transitional Care Program at Nationwide Children’s to help patients take ownership of their care at a young age, so they are ready to transition to the adult care setting when the time comes.
Many Specialists, One Location
Cloacal malformations affect the urinary, gynecologic and gastrointestinal tracts. Cloacal surgery and repair affects girls both mentally and physically. The care team includes surgeons, urologists, gynecologists, gastroenterologists, psychologists and child life specialists. Some conditions our team can address include:
- Cloacal anomalies
- Persistent cloaca
- Two uteruses
- Urogenital sinus
- Uterine didelphys
- Vaginal reconstruction
Research Leaders
Research discoveries bring new treatments. We lead the way in research on cloacal malformations and other colorectal conditions. Through our research, we developed a new approach that improves continence and long-term kidney function.
Clinical Experience
Nationwide Children’s treats more patients with cloacal malformations than any other program in the United States.
Lifelong Care
Nationwide Children’s is the only center in the U.S. to offer care from infancy through adulthood for patients with cloacal malformation.
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