ABSTRACT
A persistent cloaca is a malformation in which the rectum, vagina, and urethra are fused into a single common channel. This defect is considered one of the most formidable challenges in pediatric surgery and represents the extreme in the spectrum of complexity of female anorectal and urogenital malformations. Treatments traditionally involved repair of the rectal component of the malformation, leaving the urogenital sinus alone, planning its repair in a second stage, or performing a combined abdominoperineal approach with vaginal and rectal pull-through. Some treatments were adequate for certain malformations, but not for others. The perineal approach to the urogenital sinus was useful for low defects but not for higher defects. Similarly, the abdominal approach was required for some anomalies but not for others. These approaches were often limited in their exposure and thus could not clearly define the complex anatomy of the defect, and as with surgery for anorectal malformations (Chapter 56, Anorectal malformations), the urinary and anorectal sphincters were matters of speculation because the precise anatomy was not visualized.
