How to investigate the individual anatomy of cloacas, at...
Transcript of How to investigate the individual anatomy of cloacas, at...
How to investigate the individual anatomy of cloacas, at birth and beforereconstruction
Paola MidrioPediatric Surgery Unit Cà Foncello Regional Hospital – Treviso, ITALY
Investigation at birth:
INSPECTION, abdominal us,
(abdominal x-ray + echo)
Investigate anatomy of cloaca at birth: is this normal?
´ How many orifices?´ Normal position?´ Normal size?
´ Abdominal and renal US´à PSARP/ colostomy
Investigate anatomy of cloaca at birth: is this normal?
´How many orifices?´Normal position?´Normal size?
´ Abdominal and renal US´à PSARP/ colostomy
Investigate anatomy of cloaca at birth: is thisnormal? Case 1
´ Male or female?´ How many orifices?´ Observe micturation and
defecation (it may take 12 hours)´ ….meantime ask for abdominal
and renal US
´ US described 2 normal kidneys, double uterus, normal ovaries, no abdominal mass à girl –colostomy
Case 1Micturation and defecation
Case 2
´ Prenatal diagnosis of a girl
´ Male or female?´ Orifices??´ Urine and meconium?
´ Abdominal US + laparoscopyà girl, colostomy
Case 3
Prenatal diagnosis of a girl
Orifices?Empty “scrotum”
US: 2 normal kidneys and bladder , apparently no uterus/ovariesY chromatin test
No urine, nomal stooling
à Y positivityà Left testis in the scrotumà vesicostomy
Case 4
Prenatal diagnosisof bilateral kidneydisplasia, girl
Orifices?
Abdominal and renal US (kidneys displasia)
Micturation and defecation throughmiddle hole
-à peritoneal dyalisis for renal failure at 1 year
What do you see?
Courtesy of E.Leva, MD
What do you see?
Intestine?Heart shadow?Vertebra?Ribs?
Investigation before reconstruction:
colostogram, genitoscopy and more
Investigation before reconstruction: colostogram
Before reconstruction: colostogram
´ Information:´ Quality of sacrum´ Lenght of colon´ Morphology of
pelvic organs´ Lenght of common
channel (difficult!)
movie
Before reconstruction: genitoscopy
´ Combined 3D rotational fluoroscopic-MRI cloacagram procedure definesluminal and extraluminal pelvic anatomy prior to surgical reconstruction of cloacal and other complex pelvic malformations. Jarboe MD, Pediatr Surg Int. 2012 Aug;28(8):757-63.
´ MRI of persistent cloaca: can it substitute conventional imaging? Mohammad SA1, Eur J Radiol. 2013 Feb;82(2):241-51 MRI is a valuable tool in exploring the different internal anatomical features of the cloacal anomaly; and when combined with endoscopy, MRI can make other preoperativeconventional imaging unnecessary.
´ Magnetic resonance imaging of anorectal malformations.Podberesky DJ. Magn Reson Imaging Clin N Am. 2013 Nov;21(4):791-812.
Before reconstruction: MRI
Before reconstruction: MRI
Courtesy of
prof. I. de Blaauw
C.E.J Sloots, MD
In summary: at birth
´ ACCURATE general inspection
´ Abdominal and renal US
´ (Plain X-ray)
In summary: before reconstruction (3-6 months)
´ Colostogram
´ Cysto-vaginoscopy with measure of common channel
´ Pelvic MRI ?