How are cloacal malformations treated?

Surgery is needed to treat most cloacal problems. The type of surgery the child has depends on the nature and extent of the problem. It is important to work with a pediatric urologist who has expertise in planning and performing these types of procedures.

The first priority is usually to make sure the newborn baby is healthy and able to pass feces and urine safely. If that does not happen, she may get infections or have other complications. In this case, the baby may have a surgery to create a “loop colostomy” shortly after birth. In a loop colostomy, a loop of intestine is brought through the abdomen. It is cut only half way through, leaving the intestine otherwise intact, but with two openings. The surgeon stitches it to the baby’s skin to keep it in place. Babies also usually need a catheter to help remove urine since the bladder is often swollen. The surgeon may insert a catheter and take other steps at this time, if needed, to protect the vagina or any other organ of the body that may be affected.

As the baby ages and becomes more stable, doctors are able to consider doing surgery to reconstruct the malformed organs. This typically happens between six months and one year of age. The reconstruction involves separating out a rectum from the common channel and then using the remaining tissue to create a vagina and a urethra. This is most easily accomplished when the common channel is short (less than 4 cm).

When the common channel is longer, the same approach is attempted but it will be more complicated. Some girls with this condition will have issues with urinary incontinence afterward.

The colostomy will typically be closed after three months, and the newly reconstructed areas should begin to function normally.

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