CLOACAL MALFORMATIONS. CASE STUDIES

• Part One: Overview
1. History of Cloacal Malformations
2. Overview of Cloacal Malformations
3. Preoperative Evaluation and Surgical Planning
4. The ARM Index
5. Surgical Reconstruction
6. Urological Evaluation and Long-Term Management in Cloacal Malformations
7. Gynecologic Evaluation and Intervention in Cloacal Malformations
8. Neurosurgical Implications
9. Bowel Management
10. Long-Term Outcomes of Patients with Cloacal Malformations

• Part Two: Case Studies
Case 1 A patient with a prenatal diagnosis of a cloacal malformation

Section 1 Total Urogenital Mobilization (TUM)
Case 2 TUM in a patient with a cloacal malformation and borderline common channel and urethral lengths
Case 3 A patient with a cloacal malformation, a short channel, and a high rectum
Case 4 A patient with a cloacal malformation, a short common channel, and a tethered cord

Section 2 Urogenital (UG) Separation
Case 5 UG Separation vs. TUM in a patient with a borderline cloacal malformation who underwent a UG separation
Case 6 A patient with a cloacal malformation, a long common channel, and a high rectum
Case 7 A patient with a cloacal malformation, a long common channel, and a long urethra
Case 8 A patient with a cloacal malformation, a short common channel, and a short urethra
Case 9 Laparoscopic approach to a patient with a cloacal malformation

Section 3 Special Cases
Case 10 A patient with a cloacal malformation and a slightly hypospadic urethral meatus (Cloacal type 1)
Case 11 A patient with a cloacal malformation, a rectourethral fistula, and distal vaginal atresia
Case 12 A patient with a cloacal malformation with urethral atresia
Case 13 A patient with a posterior cloacal variant: a urogenital sinus with perineal fistula
Case 14 A patient with a cloacal malformation, Mullerian anomalies, and vesicoureteral reflux
Case 15 A patient with cloacal exstrophy
Case 16 Bowel management in a patient with cloacal malformation

Appendices
Appendix A Treatment Timeline for Patients with Cloacal Malformations
Appendix B Cloacagram
Appendix C Examination Under Anesthesia Sample Operative Note
Appendix D Electrical Stimulation of the Anus
Appendix E Operating Room Preparation
Appendix F Postoperative Care Instructions
Appendix G Applied Anatomy
Appendix H New Gynecologic Anatomic Diagrams

Within the field of pediatric colorectal and pelvic reconstruction, the most complex anatomic problem a pediatric surgeon can face is that of a cloacal malformation. The urinary tract, gynecologic system, and distal bowel all fuse into a single common channel which must be surgically reconstructed. The care of patients with a cloaca is daunting, and the spectrum of anatomic variations very wide. In this book about cloaca, the authors have brought organization to the complex, providing basic principles of care, from fetal and newborn management to the reconstruction of bowel, gynecologic systems, and urinary tracts as well as the care of patients after surgery to puberty and beyond.This is a comprehensive account of all elements of care for the cloaca patient. It includes preoperative evaluation and surgical planning, the anorectal malformation (ARM) index, surgical reconstruction, urological evaluation and long-term care. Also covered are the gynecologic evaluation and intervention, neurological implications, bowel management and the long-term management of patients with cloacal malformations. Case studies provide valuable insights into a wide range of clinical scenarios, never previously categorized so comprehensively. These studies enable the reader to understand and gain experience from detailed descriptions. Fully illustrated, in color, and with further resources available online, this is a unique resource for all clinicians within the pediatric team caring for patients with cloacal malformations.In addition, specialists across numerous fields, including colorectal surgery, urology, gynecology, and gastrointestinal motility, as well as neonatology, orthopedics, neurosurgery, anesthesia, radiology, psychology, social work, nutrition, and nursing, will find this practical clinical text and its online resources to be an invaluable when dealing with the complex needs of the cloaca patient.