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A complete perineal wound breakdown of a fourth degree laceration leading to a cloaca is a rare but devastating complication of vaginal childbirth. A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. The discussion describes our surgical approach in the context of a review of the literature.

Relatively little is known about allantois and urachal development in early humans. Serial sagittal histological sections from eight human embryos and fetuses were examined to determine allantois development. At gestational age 6-7 weeks, the primitive allantois consists of an enlarged tube located between the umbilical cord and abdominal cavity, whereas the urachus is not yet developed. At 8 weeks, the allantois gradually withdraws from the distal to the proximal end of the umbilical cord, and both the proximal allantois and the rectum (hindgut) start to develop into the cloaca. At 10 weeks, the allantois was located mostly in the abdominal cavity. The urachus forms from the distal end of the allantois and develops into a closed fibrous cord between the base of the urinary bladder and the umbilicus. The urogenital sinus forms from the proximal end of the allantois.

BACKGROUND: The preserved cloaca is a particular type of anorectal anomaly. The combination of urological, genital, and rectal abnormalities makes radical reconstruction difficult. MATERIALS AND METHODS: This study examined operations performed in 50 patients with persistent cloaca treated from 2010 to 2021. Two groups are presented: the first with 35 children and a short canal (3 cm), and the second with 15 children and a long canal (3 cm). We examined the prognosis for bowel control, the type of operation, the need for vaginal reconstruction, complications after surgery, and the days of hospital stay. RESULTS: Anomalies of the Mllerian ducts in the second group (94%) were higher than in the first (36%) (p 0.001). The sacral index and myelodysplasia did not differ in both groups. The sacral index in the first group was 0.62 0.14, and in the second group, it was 0.58 0.14 (p = 0.520). Myelodysplasia in the first group was 33%, and in the second group, it was 38% (p = 0.744). Total urogenital mobilization (51%) was used in the first group, and abdominal reconstruction (54%) was used in the second group. Vaginal reconstruction was required in 28% of patients in the first group and 60% in the second group. Complications were 3.5 times more likely in the first group (60% versus 17% in the second) (p = 0.003). The length of hospital stay in patients in the second group was longer than that of patients in the first group. CONCLUSION: Our study data demonstrate that the reconstruction of a persistent cloaca requires individual planning of the operation, considering the length of the canal and the state of all structures forming the cloaca.

The case of a toddler with long-channel cloaca, mild chronic kidney disease (CKD) due to renal dysplasia, and early onset of ulcerative colitis (UC) is herein reported. The patient underwent definitive repair of cloaca, that included vaginal elongation with colon, at 5 months of age and was admitted for episodes of vaginal bleeding at 22 months of age. A vaginoscopy revealed a severe inflammation of the colonic neovagina. As rectal bleeding was also noticed, she underwent a colonscopy that showed the same macroscopic inflammatory picture. Neovaginal and colonic biopsies confirmed UC. The mother turned out to be affected by UC since adolescence. The patient is now on oral therapy with mesalazine and topical steroid and mesalazine in the neovagina. The association between cloaca and inflammatory bowel disease (IBD) is anecdotal, but the family history of IBD should be considered when planning the surgical reconstruction of patients with cloaca. In this patient, the occurrence of UC may require a new neovagina in the future and the concomitance of CKD may complicate the overall management due to the potential nephrotoxicity of drugs used for UC therapy.

Vaginoplasty with colon is a common technique for vaginal replacement in patients with cloaca. Malignancy in the neovagina is a rare outcome and typically presents decades after reconstruction. We present a case of an adolescent female with history of cloaca, ulcerative colitis, and high-grade dysplasia of the sigmoid neovagina.

Cloaca (2000-2010), by Wim Delvoye, consists of a set of machines developed in order to produce “real industrialized shit” in Museums and Art Galleries. After a brief description of the series, we unfold our analysis on three axes: the first one is based on the psychoanalytical articulation between shit and money; the second one on the differentiation genetically formulated by Gilbert Simondon (1989) between aesthetics, technics and religion; the third one on the concept of machine, formulated by Gilles Deleuze and Felix Guattari (1972). Finally, we compare Cloaca and Anal Kisses (2011), a project by the same artist, in an attempt to identify some cultural vectors that affected the uneven reception of both projects.

Anoplostoma is characterized by buccal cavity large cylindrical, which is not surrounded by pharyngeal tissue, teeth absent, amphideal fovea pocket-like, copulatory bursa around cloaca in the male, postcloacal spine present.

Introducción: La cloaca traumática es una disrupción completa de la pared anterior del canal anal y del tabique rectovaginal generalmente como complicación del parto vaginal. Es poco común pero incapacitante. Si bien el tratamiento es siempre quirúrgico no hay consenso acerca de cuál es la mejor técnica a utilizar. Reporte de caso: se presenta una paciente de 17 años de edad, primípara con incontinencia fecal severa con 19 puntos en el Cleveland Clinic Florida Score y una cloaca traumática. La reparación quirúrgica fue diferida 9 meses. Durante el procedimiento quirúrgico el tabique rectovaginal remanente fue disecado, ambos músculos puborrectales fueron suturados a la línea media para reconstruir el cuerpo perineal. Se utilizó la técnica de overlap para la reparación del esfínter anal, finalmente se cerraron las mucosas anal y vaginal y la piel. No se realizó ostomía desfuncionalizante. La paciente presentó buena evolución postoperatoria, externándose a los 4 días. Actualmente en seguimiento a largo plazo, continúa con buena continencia. Discusión: La técnica más adecuada para la reparación de la cloaca es tema de debate. No hallamos evidencia a favor del uso de colgajos para la reparación de las cloacas traumáticas, y el cierre a la línea media tiene morbilidad similar o menor que las reparaciones complejas. La realización de ostomía no tiene ventajas y empeora la calidad de vida. Existen datos acerca de un empeoramiento de la continencia a largo plazo luego de la reparación quirúrgica. Conclusión: se presenta un caso de cloaca traumática reparado con la técnica por planos. Esta técnica podría presentar una baja tasa de complicaciones postoperatorias y buenos resultados funcionales.

Background: Ventral abdominal herniation (with or without oviduct involvement) in avian species is most commonly seen in reproductively active females. Case Description: A 2.5-year-old female budgerigar (Melopsittacus undulatus) presented for a ventral tail, 2.0 cm in diameter, mass extending between the cloaca and the tail base. Upon surgical evaluation, the mass was determined to be a herniation of the oviduct and later confirmed with histopathology. A salpingohysterectomy and closure of the body wall defect was performed, and the patient recovered well. Postoperative radiography revealed no evidence of retained egg or other obvious pathology to determine an underlying cause. Conclusions and Case Relevance: Lateral body wall herniations with involvement of the oviduct has been reported, but an undertail body wall herniation involving the oviduct has not been previously reported based on the literature search, and should be considered in birds presented with similar lesions in this anatomical location.

Aim of the Study: This study aims at evaluating the feasibility and outcome of a laparoscopically assisted rectal and vaginal pull-through procedure in the same setting for cases of long common cha...

Herein we present a case of 5-month-old female born with a cloaca. She underwent a colostomy at birth and then underwent endoscopy and cloacagram to plan for the definitive reconstruction. The case is presented with a focus on the reconstructive strategies, and questions for the readers are posed in a quiz format.

We determined the safety and efficacy of intraoperative magnetic resonance imaging guided surgical reconstruction of bladder exstrophy for the identification of the urogenital diaphragm fibers and the thickened muscular attachments between the posterior urethra, bladder plate and pubic rami.Institutional review board and U.S. Food and Drug Administration approval was obtained for the use of Brainlab (Munich, Germany) intraoperative magnetic resonance imaging guided navigation of the pelvic floor anatomy during closure of classic bladder exstrophy and cloacal exstrophy at our institution. Preoperative pelvic 3-dimensional magnetic resonance imaging was obtained 1 day before closure in patients undergoing pelvic osteotomies. Intraoperative registration was performed after preoperative planning with a pediatric radiologist using 5 anatomical landmarks immediately before initiation of surgery. Accuracy of pelvic anatomy identification was assessed by 2 pediatric urological surgeons and 1 pediatric radiologist.In 43 patients with classic bladder exstrophy and 4 patients with cloacal exstrophy closed at our institution, Brainlab technology was used successfully to navigate and guide the dissection of the pelvic floor intraoperatively. In all patients there was 100% accuracy in the correlation of gross anatomical landmarks with 3-dimensional magnetic resonance imaging identified landmarks intraoperatively, and all patients had successful closure without any major complications.Brainlab intraoperative 3-dimensional magnetic resonance imaging guided pelvic floor navigation and dissection is an effective way to accurately identify pelvic anatomy during classic bladder exstrophy and cloacal exstrophy closure. This technology offers a unique opportunity for surgical skill education in this complex reconstructive operation.

AIM A modified repair technique for traumatic cloaca caused by obstetric anal sphincter injury was evaluated, and its feasibility and functional outcome were investigated. METHODS A retrospective review of 23 consecutively enrolled patients diagnosed with traumatic cloaca who underwent the modified repair technique between September 2010 and August 2018 was performed. Demographic, clinical feature, operative and follow-up data were recorded. RESULTS The patients diagnosed with traumatic cloaca who underwent surgical repair after obstetric anal sphincter injury had a median time from obstetric injury of 24 (12-35) years. The median preoperative Wexner faecal incontinence score was 16 (14-17). The postoperative hospital stay was 6 (6-7) days. The median postoperative Wexner faecal incontinence score decreased to 2 (2-3). The anal resting pressure increased from 9.00 (5.25-11.50) mmHg to 56.00 (55.00-65.75) mmHg (P

The association of gynecological anomalies in all anorectal malformations (ARM) is firmly established. Our goal is to study this pathology in our patients to focus attention to this important issue. Retrospective study of female patients operated for ARM and who underwent magnetic resonance imaging in our center. The type of malformation, the presence and type of vaginal, uterine, tubaric and urological anomalies were studied. 63 patients were included: 34.9% cloaca, 28.6% vestibular and 12.7% perineal. Half of patients had some type of mullerian anomaly; 19 vaginal, most frequent being the longitudinal vaginal septum (66.7%); 30 had uterine alterations, most frequent being the uterus didelphys (60%). Eighty percent of patients with complex ARM (cloaca, exstrophy) presented some type of gynecological malformation compared to 21.8% found in simple ARM (stenosis, perineal, vestibular) (p

This study was conducted to investigate the anatomical, histological characteristic features of epididymis, ductus deferens and phallus of male guinea fowl (Numidia meleagris ). Fifteen healthy male guinea fowl aged between 18-24 months, weighing 1280 - 1405 gram were used in current study which brought from local market in Baghdad governorate. The epididymis of guinea fowl consisted from rete testis, efferent ductless, connecting duct and epididymal duct. The study revealed that the mean diameter of epididymal ducts was 285.17± 2.43µm lined with pseudostratified columnar epithelium. The epididymal duct continuous with ductus deferens which become wider caudally towards the cloaca, the length of right and left ductus deferens were 9.16±1.20 cm and 9.80±1.24cm respectively. The copulatory organ (phallus) of guinea fowl was not well developed and non-intermittent type consist from right and left lateral lymphoid bodies with median eminences, the transverse width 5.01±0.24mm, the cranio-caudal width 3.51±0.07mm and dorso- ventral width 4.32±0.25mm. The lining epithelium of coprodeum was pseudo stratified columnar epithelium. This study concluded that the epididymis of male guinea fowl located on dorsomedial surface of the testes and without definite parts as in domestic animals, the ductus deferens of guinea fowl was tortuous, the phallus of guinea fowl is non - intermittent type.

Highlights • Persistent cloaca with caudal duplication and a vestigial appendage is very rare. • Initial management include decompressive colostomy and drainage of the hydrocolpos. • Staged surgery include repair of cloaca and removal of accessory foot. • Preserving quality of life and managing complications is of key importance., Introduction A cloaca occurs when genitourinary tract and bowel converge into a common channel. We report a case of partial caudal duplication, persistent cloaca and vestigial appendage in a monovular female twin infant. Presentation of case This is a monochorinonic-diamniotic twin born at 36 weeks with apgars of 9/9. She had a duplicated labia with two clitorises, and a partially formed accessory foot with 2 toes protruding from the right gluteal region. There was anal atresia and a punctate urethral opening in the right genitalia through which she voided spontaneously. X-ray of the accessory foot had rudimentary metatarsals and phalanges. There was left hydroureteronephrosis and a hydrocolpos causing severe mass effect. On the first day of life, she had exploratory laparotomy with a diverting colostomy and mucus fistula and drainage of hydrocolpos. At 6 months of age, she had removal of the accessory foot with flap closure of the perineal defect and vesicostomy. At 15 months of age she had laparotomy for repair of cloaca, excision of presacral pelvic mass and the duplicated vulva. Discussion Theories of etiology include failure of regression of Kovalevsky’s canal (a communication that connects the amniotic and yolk sac), an incomplete form of twinning through iatrogenic damage to the zona pellucida or a failed triplet formation from a single embryo. Conclusion Caudal duplication with persistent cloaca and vestigial appendage is a rare and complex malformation. Having a unified surgical and medical team to preserve quality of life and to treat complications is of key importance.

Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report a case of persistent cloaca accompanying uterus didelphys that was diagnosed antenatally with fetal ultrasonography. A gravida 3, para 2, 35-year-old women at 22 weeks of gestation was referred to our hospital with a diagnosis of moderate pyelectasis of the fetal kidneys and fetal diffuse intestinal dilation. Detailed ultrasound scan findings were reported as a small thick-walled septated cystic pelvic mass of 5.2×5.5 cm size seen at the level of the fetal pelvic region. The target sign could not be visualized, it was considered as anal atresia. In the following weeks, the patient, who was evaluated together with meconium on the uterine septum, and monitoring of the neighboring bladder and anal atresia, was diagnosed as having persistent cloaca. Ultrasound findings showed that it could be persistent cloaca accompanying uterus didelphys. The fetus postnatally manifested persistent cloaca. On the first day after vaginal delivery, pelvic ultrasound in the neonatal intensive care unit showed bilateral 2nd-degree hydronephrosis, presacral enlarged bowel loops, uterus didelphis, vaginal septum, direct contact between urethra and vagina, proximal end in the rectum compatible with atresia. On the second day, colostomy was performed. Her renal condition continued to be stable. She is now waiting for definitive surgery for cloaca. Persistent cloaca should be considered in any female fetus presenting with hydronephrosis and a cystic pelvic mass lesion as diagnosed by ultrasound. Prenatal diagnosis allows time for parental counseling and delivery planning at a tertiary hospital for neonatal intensive care and pediatric surgery.

The male urogenital system of salamanders varies both among families and within them. To understand diversity of this system in hynobiids, we studied the gross anatomy and histology of the male urogenital system of a mountainous rheophilic salamander, Ranodon sibiricus. Males had single-lobed, lobular-cystic testes which were characterized by the presence of ‘lobular waves'. The sperm transport system included the vasa efferentia, longitudinal collecting ducts of the vasa efferentia, the genital kidneys, and Wolffian ducts leading to the cloaca. There were also rudimentary Mullerian ducts. The cloaca contained ventral glands. The structure of the male urogenital system of R. sibiricus was similar to the genera Batrachuperus, Hynobius, and Salamandrella.

In this review, the care of children with a previously repaired anorectal malformation is explored. We know that the surgical care of children with anorectal malformations is complex; however, despite an increased understanding of the congenital anomaly and significant technical advances in the operative repair, many of these children continue to have poor functional outcomes. In this article we focus on the common surgical complications, discuss typical presentations, consider appropriate investigations, and review the risks and benefits of revisional surgery in those patients that are 'not doing well' following their primary reconstruction.

Optimal outcomes in the management of children with Anorectal Malformation (ARM) require careful surgical preparation and detailed understanding of the anatomic principles and operative setup. A clear understanding of operative anatomy and surgical principals guides decision making. Adherence to the principles of ARM repair, as well as the application of operative and imaging adjuncts, will yield the safest and most successful approach to ARM. In this review, we detail the surgical preparation, anatomic principles, and surgical management issues unique to ARM.

Understanding the developmental embryology, anatomy and the unique physiologic properties of the Gastrointestinal Tract is essential for the surgeon to provide proficient surgical treatment for the pediatric patient. This chapter aims to equip the surgeon with the foundational knowledge needed to manage the broad spectrum of congenital and acquired pathology that can affect the gastrointestinal tract.

Our knowledge of the reproductive biology of dinosaurs covers a range of aspects, from brooding behaviour to nesting style and the timing of sexual maturity. Yet, the basic anatomy and function of the cloaca in non-avialan dinosaurs remains unknown. Here, we describe the outer morphology of the only known non-avialan dinosaur cloaca, preserved in an exceptional specimen of the early-diverging ceratopsian dinosaur Psittacosaurus. We clarify the position of the cloaca with respect to the ischia and caudal vertebrae and document the scales immediately adjacent to the abdomen and tail. We find that the cloaca is from a near-sexually mature subadult individual and is most similar to the cloaca of crocodylians, to the exclusion of lepidosaurians and birds. However, the sex of SMF R 4970 could not be determined as the cloaca and the rest of the specimen does not yield any sexually dimorphic information. This study highlights the ongoing role of exceptional specimens in providing rare soft tissues that help to bridge longstanding gaps in our knowledge of the basic biology of dinosaurs and other extinct reptiles.

Terminal myelocystocele is a rare type of neural tube malformation, consisting of a skin-covered lumbosacral mass, highly associated with other complex abdominal malformations within the OIES complex (omphalocele, imperforate anus, exstrophy of the cloaca and spinal defects). We present a case of a premature female with an extensive lumbosacral mass at birth, as well as an omphalocele, cloacal exstrophy, renal abnormalities, and sacral agenesis. Lumbar magnetic resonance imaging revealed a meningocele sac herniating through the bone defects and containing a syringocele sac. Advanced imaging techniques showed turbulent cerebrospinal fluid flow. At control, 4 weeks later, the defect doubled in size. The myelocystocele sac was evacuated and closed, and the patient persisted with paraparesis. The role of cerebrospinal fluid flow analysis is well established in Chiari-type malformations, in which turbulent flow within the syrinx is related to a better outcome after surgery. It is possible that the same principle could be applied to other spinal malformations, as shown in this case of terminal myelocystocele.

Previous studies in developing Xenopus and zebrafish reported that the phosphate transporter slc20a1a is expressed in pronephric kidneys. The recent identification of SLC20A1 as a monoallelic candidate gene for cloacal exstrophy further suggests its involvement in the urinary tract and urorectal development. However, little is known of the functional role of SLC20A1 in urinary tract development. Here, we investigated this using morpholino oligonucleotide knockdown of the zebrafish ortholog slc20a1a. This caused kidney cysts and malformations of the cloaca. Moreover, in morphants we demonstrated dysfunctional voiding and hindgut opening defects mimicking imperforate anus in human cloacal exstrophy. Furthermore, we performed immunohistochemistry of an unaffected 6-week-old human embryo and detected SLC20A1 in the urinary tract and the abdominal midline, structures implicated in the pathogenesis of cloacal exstrophy. Additionally, we resequenced SLC20A1 in 690 individuals with bladder exstrophy-epispadias complex (BEEC) including 84 individuals with cloacal exstrophy. We identified two additional monoallelic de novo variants. One was identified in a case-parent trio with classic bladder exstrophy, and one additional novel de novo variant was detected in an affected mother who transmitted this variant to her affected son. To study the potential cellular impact of SLC20A1 variants, we expressed them in HEK293 cells. Here, phosphate transport was not compromised, suggesting that it is not a disease mechanism. However, there was a tendency for lower levels of cleaved caspase-3, perhaps implicating apoptosis pathways in the disease. Our results suggest SLC20A1 is involved in urinary tract and urorectal development and implicate SLC20A1 as a disease-gene for BEEC.

The black-bone chicken (Gallus gallus domesticus) is a breed of chicken that is commonly found in Thailand. This breed is known for having a number of black colored organs. Consumers have been notably attracted to the black-bone chicken breed for the characteristic darkness that is observed in many of its organs. However, the degree of darkness in all organs of the black-bone chicken is still in question. Importantly, there have not yet been any published reports on the distribution of melanin pigment in the organs of the black-bone chicken. This research study aims to examine the distribution of the melanin pigment in 33 organs of the Thai black-bone chicken. Ten black-bone chickens (five male, five female) were included in this study. Thirty-two organs including the brain, spinal cord, sciatic nerve, larynx, trachea, syrinx, lungs, heart, pericardium, aorta, brachial vein, kidney, cloaca, oviduct, testis, gastrocnemius muscle, femur, tongue, esophagus, crop, proventriculus, gizzard, duodenum, jejunum, ileum, cecum, pancreas, liver, gall bladder, omentum, abdominal fat, spleen, and skin were examined in this study. Histological sections taken from tissue samples of each of these organs were studied. The findings revealed that the presence of the melanin pigment was not significantly different (p &gt, 0.005) between male and female specimens. Notably, the liver was the only organ in which the melanin pigment had not accumulated. Consequently, there was not a uniform pattern of melanin pigment accumulation throughout the organs of the chickens. The melanin pigment was present in all of the tissue layers of most organs, while the melanin pigment was found in only specific layers of some of the organs. In conclusion, the distribution of melanin pigmentation in the organs of each of the animals in this study was found to be different. However, in some tissue samples, such as those obtained from the liver, no accumulation of the melanin pigment was observed.

Urinary incontinence in a child secondary to a severe congenital anatomical disorder or due to complication of a previous surgery can be difficult to manage. Decisions can be especially hard when a redo procedure is being considered. We present one such case where a 6 year old girl previously operated for cloaca was brought with incontinence and after much consideration of options available, underwent a modified ureterosigmoidostomy to aid in her continence. The modification used was detubularized isolated ureterosigmoidostomy, described by Atta et al in 1996.

Eine der haufigsten Missbildungen der Harnwege ist die einfache Ektopie der Niere, bei der das Organ im kleinen Becken liegt. Bei der etwas selteneren gekreuzten Ektopie liegt die Niere auf der kontralateralen Seite in Bezug zur Uretermundung in die Harnblase, d. h., ihr Ureter kreuzt die Mittellinie des Korpers. Die Ursache dafur ist das Ausbleiben des Aszensus, des Aufstiegs der ursprunglichen Niere aus dem Becken in die orthotope Lage. Ein beschleunigter Aszensus fuhrt hingegen zur intrathorakalen Nierenektopie. Ektope Ureteren munden auserhalb des Trigonum vesicae. Bei Storungen in der Organogenese kann deren Orificium sowohl in Blasenhals und Urethra als auch im Bereich der Geschlechtsorgane liegen. Die Blasenekstrophie ist ein fehlender Verschluss der vorderen Bauchwand, sodass die Blasenschleimhaut in die umgebende Haut ubergeht. Bei der kloakalen Ekstrophie ist die Harnblase gespalten, dazwischen liegt der ileozokale Anteil des Darms. Als Hodenektopie bezeichnet man die Lage des Organs auserhalb der Deszensuswege. Bei der Ektopie der Prostata handelt sich nicht um eine Fehllagerung des gesamten Organs, sondern um versprengte Prostatadrusen, die vor allem in der Blasenwand und in der Urethra zu finden sind. Einige Falle wurden aber auch in der Darmwand, im Anus, im perikolischen Fettgewebe, Milz, Samenblase, Hoden sowie in der Cervix uteri und Vagina beschrieben. Die Penis- und Skrotumektopie und die penoskrotale Transposition sind die seltensten Missbildungen der mannlichen Geschlechtsorgane uberhaupt. Die seltenste Form ist die gemeinsame Verlagerung von Penis und Skrotum ins Perineum. Bei der Transposition liegt hingegen der Penis unter dem Skrotum oder zwischen beiden Hoden in einer Furche des gespaltenen Hodensacks.

Caring for patients with congenital pelvic anomalies can be challenging in many ways but one crucial aspect is providing longitudinal into adulthood. Newborns with urinary, intestinal or vaginal obstruction require urgent operations to relieve obstruction followed by multiple reconstructive procedures involving the perineum. Openings are created in the pelvic floor musculature that did not exist in development. Adolescence presents further challenges for these postoperative patients while other diagnoses present for the first time in the peri-pubertal teenage years. Young adults can have new symptoms when they become sexually active and are faced with reproductive decisions. During all of these time periods, optimization of function is of paramount importance and patients who are suffering are not able to participate in school, sports or work. This study evaluates the prevalence of pelvic pain in newborns and adolescents with complex congenital pelvic anomalies, associated factors and possible treatment options.

A 40-year-old pregnant woman presented with a fetal abdominal cyst and oligohydramnios. Color Doppler scan revealed a single blood vessel from the fetal aorta into a single umbilical artery. Severe oligohydramnios limited ultrasonographic evaluation of the fetal lower limbs, kidneys, or bladder. The pregnancy was terminated; the fetus showed fused lower limbs, bulging abdomen, and absent external genitalia and was diagnosed with type III sirenomelia. On autopsy, no normal bladder was observed, but duodenal atresia, anorectal atresia, and right renal agenesis were found. An intra-abdominal cyst, diagnosed histologically as a saccular cloaca, occupied the abdominal cavity. Ultrasonographic diagnosis of fetal sirenomelia is difficult due to poor depiction of the lower limbs. A vitelline artery leading to a single umbilical artery and a fetal abdominal cyst occupying most of the abdominal cavity are considered fetal sirenomelia associated with large defects of the gastrointestinal and genitourinary tracts., 論文

Five female egg-laying pigeons presented with painless, reducible, ventral abdominal swellings located between the keel and the pubis, or close to the cloaca. Based on clinical, radiographic, and ultrasonographic examination, these pigeons were diagnosed with ventral abdominal hernia requiring surgical interference. Reduction was successfully performed under general anesthesia. Radiographic and ultrasonographic examinations were beneficial for confirming the diagnosis and visualizing the hernial content for surgical planning. Lateral radiographs were more helpful than ventrodorsal radiographs for identification of the hernial content and its continuation with the abdominal muscles. Ultrasonographic examination offered a non-invasive diagnostic tool that allowed for the differentiation of hernia from other abdominal swellings. In addition, it played a beneficial role in identification of the hernial content and follow up after surgical interference. In conclusion, radiographic and ultrasonographic examinations were beneficial in the diagnosis, surgical planning, and follow up after surgical interference of ventral abdominal hernia in pigeons.

We report a 6-year-old girl with female hypospadias and discuss the definition and management of the entity.

Caudal duplication syndrome (CDS) is a rare developmental anomaly in which embryonic cloaca and notochord structures are duplicated [1]. Due to the diverse clinical manifestation and rarity of CDS, it is crucial to report every case and to share experience and outcomes of individually adjusted management plans. We report here the case of a 2-year-old girl born with duplication of the urogenital (bladder, urethra, uterus, vagina, vulva) and gastrointestinal (gallbladder, appendix vermiformis) systems. Additionally, coccygeal agenesis, lipomyelomeningocele and vertical talus were present. A thorough examination and urological reconstructive surgery were performed. While there may be a desire from patients, parents and healthcare specialists to modify all malformations to an anatomically correct state, the current opinion is that only anatomical variants that influence function should be modified. Consent from patients should be sought for decisions regarding more sensitive matters such as vulva surgery for cosmetic reasons or correction of anatomical variants without functional consequences.

Functionally, the urogenital system can be divided into two completely different components : urinary system and genital system. However, embryologically and anatomically, the two are closely related. Both originate from a single mesodermal ridge (intermediate mesoderm) along the posterior wall of the abdominal cavity, and initially, the excretory ducts of both systems enter the same cavity, the cloaca. The urogenital system is a system consisting of the urinary system which is divided into the urinary tract and the genital system. Where the urinary system is divided into the upper and lower urinary tracts. The upper urinary tract consists of the kidneys, renal pelvis and ureters, while the lower urinary tract consists of the urinary bladder and urethra. The external genital system in men and women is different, in men it consists of the penis, testes and scrotum, while in women it consists of the vagina, uterus and ovaries. The following will describe the urogenital system in women

International audience; Anorectal malformations (ARMs) are relatively common congenital abnormalities, but their pathogenesis is poorly understood. Previous gene knockout studies indicated that the signalling pathway mediated by the retinoic acid receptors (RAR) is instrumental to the formation of the anorectal canal and of various urogenital structures. Here, we show that simultaneous ablation of the three RARs in the mouse embryo results in a spectrum of malformations of the pelvic organs in which anorectal and urinary bladder ageneses are consistently associated. We found that these ageneses could be accounted for by defects in the processes of growth and migration of the cloaca, the embryonic structure from which the anorectal canal and urinary bladder originate. We further show that these defects are preceded by a failure of the lateral shift of the umbilical arteries and propose vascular abnormalities as a possible cause of ARM. Through the comparisons of these phenotypes with those of other mutant mice and of human patients, we would like to suggest that morphological data may provide a solid base to test molecular as well as clinical hypotheses.

We present a case of a girl with an extremely rare, posterior type of persistent cloaca, which was associated with other abnormalities, including an undeveloped vulva and vagina, agenesis of the right kidney, secondary obstructive megaureter, unicornate uterus, persisted tailgut, sacral bone hypoplasia, and pubic symphysis hypertrophy. An operative approach was as follows: (i) colostomy and ureterocutaneostomy; (ii) creation of an ileal conduit with antirefluxing uretero-ileal anastomosis, and then creation of a continent catheterizable ileal reservoir; (iii) anastomosis of sigmoid colon to rectal stump; and (iv) vaginal and external genital reconstruction. Because of abnormal anatomical conditions where the uterus was situated adjacent to the open, incompetent bladder neck, we decided to create a vagina using the bladder wall instead of the bowel segment.

We studied the ultrastructure of the digestive system in late doliolaria, pentactula, and 1-month-old juvenile of the holothurian Apostichopus japonicus. In late doliolaria and pentactula, the digestive system is divided into three segments: pharynx, gut, and cloaca. Pharynx and the posterior part of cloaca are lined by cuticular epithelium and apparently of ectodermal origin. The anterior part of cloaca and the entire gut is not differentiated histologically and is lined by a single type of digestive cells, vesicular enterocytes I. These cells are characterized by large secretory granules, containing an acidic substance, found in cytoplasm. As the anterior part of the cloaca is lined by cells typical of the endodermal segment of digestive tube (vesicular enterocytes I), we suggest this part to be of endodermal origin and probably formed from the larval stomach. In 1-month-old juveniles, the structure of the digestive system grows more complicated. In addition to vesicular enterocytes I, three more types of enterocytes appear in luminal epithelium. The specific distribution of the four types of digestive cells divides the intestine into three parts, each probably performing its own function. All enterocytes develop long microvilli, which indicate the intensification of the extracellular digestion processes and an increased absorption of dissolved nutrients.

Urachal cancer is a rare and extremely aggressive malignancy deriving from an embryological remnant of the urogenital sinus and allantois. It represents

*The lower end of the hindgut dilates to form an expanded part called the cloaca (endodermal).

Anorectal malformations, or imperforate anus, represent a wide range of congenital defects and are associated with other congenital anomalies, including cardiovascular, urologic, gastrointestinal, and musculoskeletal disorders. Appropriate work-up for associated anomalies should be performed prior to definitive management. After the diagnosis of an imperforate anus is made on newborn examination, evaluation for a fistula should be performed, and oftentimes the definitive anatomy is not known until after a fistulogram. In females with a single perineal opening or cloaca, the common length channel should be assessed using cystoscopy, vaginoscopy, and possibly magnetic resonance imaging (MRI). Hydrocolpos should be drained if found. In a patient without a fistula, an abdominal X-ray should be performed to evaluate the distance between the distal gas and the skin. In patients with more complicated anomalies, such as cloaca, recto-urethral fistulas and patients with rectal gas above the coccyx on abdominal X-ray, colostomy should be performed first and definitive repair delayed until further work-up can be performed. Otherwise, superficial fistulas may be managed with anoplasty and deeper fistulas managed with posterior sagittal anorectoplasty in males or posterior sagittal anorectovaginourethroplasty in females.

Complete colonic duplication is rare, and usually occurs as a part of the caudal duplication syndrome. In such cases, the diagnosis is clinically evident by the presence of two ani arranged side by side in the perineum, which is commonly associated with duplication of the external genitalia as well (double phallus or double vestibule). In this report, we present a special case of anorectal anomaly that was associated with complete tubular colonic duplication. The diagnosis was initially missed due to the uncommon sagittal arrangement of duplicated rectum: one rectum was ending externally into the perineum by rectoperineal fistula, while the other was hidden by its internal termination into the vagina. Our final diagnosis for this case was a variant of anorectal anomaly in the female, which was associated with complete colonic duplication. One colon (which was in the free mesenteric border) terminated anteriorly into the vagina as a part of a “short common channel” cloaca, while the other colon terminated by rectoperineal fistula. Although the anomaly seems to be rather complex and confusing, yet our case was associated with an excellent outcome due to the benign type of anorectal anomalies (rectoperineal fistula and “short common channel” cloaca) and absence of significant sacral dysplasia; in addition to adequate identification of the abnormal anatomy by appropriate investigations and the staged approach for surgical reconstruction.

Background The mechanisms by which the rete testis joins the efferent ducts, which joins the Wolffian duct during development, are not known. Mouse and chick models have been helpful in identifying genes that are important for the development of each part, but genes have not been identified as to those that play a role in the joining of each part. Clinical implications of the failure of the male reproductive tract to form a fully functional conduit for spermatozoa are not trivial. Epididymal disjunction, the failure of the efferent ducts to join the testis, is one of several epididymal anomalies that have been observed in some boys who were cryptorchid at birth. Objective A systematic review of studies focusing on the morphogenesis of the mesonephric duct and mesonephric tubules in different species, and identification of clinical issues should there be failure of these tissues to develop. Design PubMed and GUDMAP databases, and review of books on kidney development were searched for studies reporting on the mechanisms of morphogenesis of the kidney and epididymis. Main outcomes measure(s) Gaps in our knowledge were identified, and hypotheses coupled with suggestions for future experiments were presented. Results A total of 64 papers were identified as relevant, of which 53 were original research articles and 11 were book chapters and reviews covering morphogenesis and clinical issues. Investigators utilized multiple species including, human, mouse, chick, Xenopus, bovine, and sheep. Conclusion Fundamental understanding of the morphogenesis of the male reproductive tract is limited, especially the morphogenesis of the rete testis and efferent ducts. Therefore, it is not surprising that we do not understand how each part unites to form a whole. Only one mechanism of joining of one part of the tract to another was identified: the joining of the Wolffian duct to the cloaca via controlled apoptosis.

Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in females and includes a spectrum of abnormalities. The urinary tract, genital tract and rectum open into a common channel, which exteriorises as a single perineal opening. We are reporting a patient with a novel variation in the classical anatomy of the cloaca. The child has a short blind-ending colon with a cecovesical fistula associated with mullerian agenesis and lipomyelomeningocoele. The child is being managed in a stepwise approach and she has completed the anal reconstruction. Here, we discuss this novel variation in anatomy and challenges in its management.

Background: A female neonate with anorectal malformation (ARM) may have one, two, or three openings in the perineum. One opening represents cloaca while three openings usually suggest low ARM. Females with two openings in the perineum may be ARM without any fistula, rectovaginal fistula, or absent vagina. The association of ARM with multiple intestinal atresias and malrotation is rare. Case Presentation: We present here a case of a female neonate with two perineal openings, whose perineum was explored by a general surgeon without any radiological investigation and was later found to have a high ARM, multiple jejunal and ileal atresia with malrotation. Conclusion: ARM associated with small bowel atresia and malrotation are rarely described. Such cases require management in Pediatric surgery settings.