ABSTRACT
A persistent cloaca (from the Latin word cloaca meaning sewer or drain) is a malformation in which the rectum, vagina, and urethra are fused into a single common channel. This may have a variable length from 1 to 10 cm and is considered one of the most formidable challenges in pediatric surgery. In retrospect, it seems likely that many patients with persistent cloaca were erroneously thought to have a rectovaginal fistula. The goals of treatment of cloaca include reconstruction of urethra, vagina, and rectum, and the achievement of bowel control, urinary control, and sexual function. Once the clinical diagnosis of a cloaca has been established, the next step is to perform an emergency urologic evaluation, which includes an abdominal and pelvic ultrasound to exclude hydronephrosis, hydroureter, and/or hydrocolpos. Thorough endoscopic examination is essential for infants with cloaca to try to determine the anatomy. This can be done during same anesthesia given to perform the initial colostomy and/or drainage of hydrocolpos.
