Cloaca is a term for a complex anorectal and urogenital malformation in which the urinary tract, vagina, and rectum all come together and form one common channel with one opening between the labia. Because this malformation includes vagina specifically, it can only truly occur in girls, although another term, cloacal exstrophy, is used to describe a different malformation seen in both genders. If you missed the part on my home page where I explain why I have a picture of a bird in the top left corner, it's because birds are naturally born with a cloaca. For them it's a normal arrangement, but for human baby girls, it's a very complex and challenging malformation. Thanksfully, we can help! Cloaca patients in general do extremely well and live full and happy lives.
Like all malformations, not all cloaca are the same. We tend to use terminology developed by Alberto Peña to classify cloacal malformations by the length of their common channel. When the channel is less than 3 cm., we consider it a 'short common channel', and over 3 cm we call it a 'long common channel'. That's a very general classification scheme, as some 'short' cloacas can be very complicated and some longer ones can sometimes be fairly straightforward. In all cases our goal is to give the child normal path to get rid of stool, urine, and have anormal vagina for sexual function. That's the long-term goal, but in the short term the child has an immediate life-threatening problem - the cloaca is not an adequate channel for stool to pass through. This gives the baby an intestinal obstruction that must be relieved. In the immediate newborn period that obstruction should not be relieved by embarking on a long and complex repair of the entire cloacal malformation, as you can do real damage that way. The child needs a surgery to give a safe way for stool to pass - the creation of a colostomy. I
Every child born with a cloaca is unique and requires an individualized care plan that recognizes the unique challenges that come with having a cloaca. some of the things we think about in the newborn period are as follows:
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Associated malformations and illnesses (that's a standard for all babies with malformations that require surgical correction)
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The presences of hydrocolpos - a dilated fluid-filled vagina. This is a major thing that one can see with girls born with cloaca, that you don't see with other malformations. The hydrocolpos can really complicate matters because it can create a urinary outflow obstruction. If that's the case, the hydrocolpos must be dealt with in the newborn period, ideally at the time of colostomy creation.
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The colostomy creation itself must be done with consideration for the future reconstruction.
If you, or someone you know, has had a child born with a cloacal malformation, we would be delighted to help in any way we can. If you're in my area, give me a call. If you are far away and unable to bring your child for immediate care, you most likely have good safe pediatric surgeons in your area who can get you child started on the path to success. If they don't do much of this work, we're happy to help and are always available to advise a colleague over the telephone.