Male cloaca: A rare case report

Purpose:To evaluate the factors which contribute to the time of the first stool and the first urine passage. Methods:We retrospectively reviewed a chart of 1,221 infants ≥34 weeks of gestational age admitted to the normal newborn nursery of Il Sin Christian Hospital, Busan, from November 2004 to April 2005. We compared the time to first stool and urine according to maternal factors(maternal age, parity, mode of delivery, meconium-stained amniotic fluid, and maternal diabetes) and infant factors (gender, Apgar score, gestational age, type of feeding during first 24 hours, age at the first feeding, number of feeds during the first 12 hours and age at discharge). Results:In total, 95.3 percent of our infants had passed their first stool by 24 hours and 99.8 percent of them had a stool by 36 hours. A total of 95.8 percent of our infants had passed urine by 24 hours of age and 98.3 percent of them by 36 hours. Comparing preterm and term infants, the time to first urine is 6.5±5.8 hours and 12.1±6.6 hours, respectively(P=0.000). The time to first stool is 20.7±13.5 hours and 10.0±6.3 hours, respectively(P=0.000) Early-fed infants were significantly earlier in time to first urine(P=0.023) and first stool(P=0.012). There was no statistically significant relationship between the number of feeds in 0-12 hours, mode of delivery, Apgar score, parity, gender, type of feeding, maternal diabetes and the time of the first urine and first stool. Conclusion:Gestational age, birth weight and age at first feeding were significantly related to the time of the first urine and first stool passage. When there is delayed passage of the first urine and first stool, we should consider close observation of other associated symptoms and other factors previously mentioned, to avoid extensive evaluation and intervention.

Cloacal malformations are rare and are typically reported in females. There are a few scattered reports in males. It is not clear why they are so rare in males since both sexes negotiate this stage of embryonal development. The present study aims to share our experience and review all the cases of persistent cloaca and cloacal variants in males reported in the literature. The male cloaca is defined as a single common channel of varying lengths with separate inlets for the urinary tract (urethra) anteriorly and the rectum posteriorly at its cranial end and with a solitary perineal orifice/opening for external drainage. We also carried out an electronic literature search for cloaca, persistent cloaca, common cloaca, cloacal dysgenesis, cloacal malformation, cloacal membrane agenesis, urorectal malformation sequence, rectourinary perineal fistula, sirenomelia, and caudal regression syndrome. After eliminating other cloacal anomalies and persistent cloaca in females, we found a total of 22 males with persistent cloaca or cloacal variant reported in the literature. In addition, we are adding two cases we have managed since our previous report. An effort should be made to search for the presence of the common channel in male patients with a single perineal opening. Recognition of the anomaly, width of the common cloacal channel, location of the rectal pouch with relation to the sacrum or pubis, status of the spine and sacrum, and nature of the anal sphincter are vital pieces of information to successfully manage the anomaly. It would be worthwhile if future reports on the subject also include long-term information about urinary and fecal functions and continence.

A 3-day-old term male child weighing 2.1 Kg, born by spontaneous vaginal delivery, was admitted with complaints of abdominal distention, meconuria and absent anal opening. This was the first child of the couple who had a non-consanguineous marriage. On examination, there was abdominal distention, poorly developed gluteal folds and an absent anal opening. Plain X-ray abdomen showed two large air fluid levels (Fig. 1). At exploratory laparotomy, Saxena-Mathur classification type 5 congenital pouch colon (CPC) was found. Ileum was opening directly into a hugely distended pouch; there was no appendix. The pouch was dumbbell shaped with normal looking intervening colon of about 5 centimeters. The dumbbell shaped pouch (proximal and distal components) was opening into the bladder through a wide fistula. The proximal part of intervening colon was not communicating with the proximal pouch but was intimately adherent to it. However, the distal part of the intervening colon was communicating with the distal pouch. Both the dumbbell shaped pouch and the terminal colon were receiving blood supply from a prominent marginal vascular pattern (Fig. 2). The distal pouch and intervening normal-looking colon appeared dusky with doubtful viability, so it was excised. Tubularized proximal pouch was brought out as end colostomy. The histopathological examination revealed the disorganized muscles in the muscularis layer of pouch colon; the intervening colon had normal colonic histology though there was evidence of congestion. The child is awaiting definitive repair.

RECTOVAGINOPLASTY FOR VAGINAL ATRESIA WITH ANORECTAL MALFORMATION

Introduction: Cloacal malformation is an extremely rare fetal pathological condition but an important anomaly that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births. Prenatal ultrasonography usually showed oligohydramnios and the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia and a single umbilical artery. Postnatal finding including ambiguous genitalia and rectal atresia with a single perineal opening. Case report: The purpose of this case series was to illustrate characteristic prenatal sonographic features of cloacal malformation by using imaging from 3 cases seen in all academic centers to augment published data. The imaging feature common to all cases was a central cystic pelvic mass containing a characteristic fluid-fluid level. Conclusions: The children were followed at regular intervals by an urologist, surgeon and nephrologist throughout life. Medical teams were committed to providing long-term care for children with cloacal anomalies.

Cloacal malformation is an extremely rare fetal pathological condition that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births. Prenatal ultrasonography on a 20-year-old caucasian woman (G4P1A2) at 33 weeks of pregnancy showed the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia, and a single umbilical artery. The pregnancy developed accentuated oligohydramnios, and presence of a fetal brain-sparing effect was diagnosed using arterial Doppler velocimetry. The newborn showed abdominal distension, ambiguous genitalia, and rectal atresia, with a single perineal opening. Pelvic ultrasound done on the first day after delivery revealed the presence of a large retrovesical septated cystic mass of dense content in the fetal abdomen, and bilateral hydronephrosis. Hysterotomy was performed, and 70 mL of dense liquid was drained through an abdominal colostomy. The infant died on the 27th day of life as a result of infectious complications. Prenatal diagnosing of female urogenital anomalies is usually difficult because of their rarity, different types of manifestation, and lack of characteristic ultrasound signs. Presence of a septated cyst with dense content in the fetal abdomen confirms the finding of hydrometrocolpos, thus raising clinical suspicion of a cloacal anomaly.

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.

Presentation of CaseA 52-year-old man was admitted to the hospital with a diagnosis of Caroli's disease associated with recurrent obstructive jaundice, fever, and bacteremia.He was well until 28 years earlier, when jaundice developed. A liver biopsy, performed elsewhere, was complicated by perforation of the common bile duct, and an emergency cholecystectomy and choledochoduodenostomy were performed. The patient was well thereafter except for occasional brief bouts of jaundice, accompanied by the passage of dark urine and light stools that were usually associated with an upper respiratory tract infection, which was rarely accompanied by fever and never required admission to . . .

A 28 years old male with well developed secondary sexual characteristics was admitted in BSMMU with a grossly swollen, malformed phallus and passage of urine mostly through an opening in the perineum. After birth, his parents noticed that when the baby micturates the phallus is swollen and few drops of urine comes out through the external urethral meatus but most of the urine comes out through an opening in the perineum. No treatment was taken by his parents for this complaint. At puberty his secondary sexual characteristics developed normally. He felt sexual urge towards females but his penis was not erected. At the peak of his sexual excitement, orgasm occurs with release of whitish seminal fluid which comes mostly through perineal opening. His general physical examination was unremarkable & examination of the genitalia revealed well developed scrotum. Both of the testes were normal in size, shape and consistency but the penile shaft was large and flabby, and the ventral aspect of the penis appeared as a sac with mild pseudo phimosis. Careful palpation suggested the absence of the corpus spongiosum & corpora cavernosa. Both these findings were subsequently confirmed by a duplex colour doppler study. The penis distended ventrally when he tried to micturate and the urinary stream was narrow. About 75% of urine flow evacuates through perineal opening which was located about 2 cm from anal opening in the midline ventrally. A voiding cystourethrogram revealed that whole of the anterior urethra was grossly dilated with narrowing at the bulbar part & external urerthral meatus. There was another passage (about 5 cm) from the scrotal margin up to proximal posterior urethra. Cystogram showed a bladder diverticulum at left lateral wall. An urethrocystoscopic examination revealed that just proximal to the stenosed external urethral meatus the urethra is widely dilated which seemed like a transparent fusiform sac with irrigating fluid. Whole of the anterior urethra was very thin walled with transmitting lights through it. Proximal part of the urethra near the external sphincter was grossly narrowed. Urethrocystoscope was also introduced through the abnormal urethral opening into the perineum which was located in the midline raphe of the perineal region about 2 cm from the anal verge. This urethra joined with the penile urethra distal to the external sphincter. Prostatic part of the common urethral channel was normal containing verrumontanum and a normal bladder neck. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.53-56

Imaging is essential in the diagnosis, management, surgical planning and eventual outcome in patients with anorectal malformation (ARM). This article outlines the imaging that may be required and the information needed by the surgeon to attain the best possible surgical outcome. ARM encompasses a wide spectrum of congenital malformations relating to the distal rectum and anus as well as the urinary and or gynaecological systems. The malformations range from a relatively simple perineal fistula with the potential for an excellent functional outcome, to complex cloacal malformation that requires specialist care and intervention. Approximately half of these children will have associated abnormalies. In the first 24–48 hours of life, imaging is used to determine if any associated anomalies are severe enough to preclude an operation, and what operation will be required so that the child can grow as normally as possible. If a colostomy is done, pre-definitive repair imaging in the form of a high-pressure distal colostogram determines the surgical approach required to repair the malformation. In more complicated cases of cloacal malformation, advanced imaging in the form of MRI or 3D fluoroscopy is valuable. In the South African setting, 2D fluoroscopy with the surgeon present is adequate to help in planning for the surgical management. Communication between the radiologist and paediatric surgeon is essential to ensure that such patients have the best possible outcome.

Churg-Strauss syndrome (CSS) is a rare multisystemic condition characterized by asthma, blood and tissue eosinophilia, and vasculitis. The purpose of this work is to present a detailed overview of CSS, focusing on its epidemiology, clinical symptoms, histological criteria, gastrointestinal involvement, and therapy. The authors report a case of a 40-year-old woman with CSS who had peripheral eosinophilia, small vessel vasculitis, and bronchial asthma. Diagnosed with symmetric polyarthritis six months ago, experienced abdominal pain, vomiting, and loose faeces. Diagnostic tests revealed CSS with systemic involvement. In addition, we undertake a literature analysis to emphasize essential elements of CSS, such as its rarity and the difficulties in diagnosing and managing it. CSS can cause gastrointestinal symptoms including stomach pain, diarrhoea, mucosal ulcers, rectal bleeding, and bowel perforations. Corticosteroids and immunosuppressives are routinely used in treatment, with caution due to the risks of long-term steroid use. The goal of treatment should be to induce remission while minimizing side effects. CSS is a rare condition, with an annual incidence of 2.4 per million and a prevalence of 1.3 per 100000. The illness typically presents with necrotizing vasculitis, extravascular granulomas, and eosinophilic tissue infiltration. CSS is a complex and rare condition that requires high clinical suspicion, especially when patients present with gastrointestinal symptoms in addition to asthma and eosinophilia. This case study adds to our understanding of CSS and emphasizes the significance of a holistic strategy for its management.

VACTERL represents an acronym for a broad spectrum of congenital anomalies such as vertebral anomalies, anorectal anomalies (anal atresia), cardiac anomalies, tracheoesophageal fistula or atresia, renal anomalies, and limb anomalies. We present the case of a male fetus with multiple anomalies consistent with VACTERL association such as scoliosis, imperforate anus, common truncus arteriosus, tracheoesophageal fistula associated with inferior esophagus atresia, polycystic kidneys, with short right ureter, lower limb hypoplasia micrognathia, hygroma, duodenal atresia, and cloacal malformation, with an aberrant omphalomesenteric duct. The presented case highlights the crucial importance of pathologists specialized in the dissection and confirmation of fetal abnormalities as an essential part of the multidisciplinary team that establishes the management of complicated pregnancies with this type of pathology.

The demonisation of the human male prepuce has been an unscientific process, even though some research, on the surface, might seem to support it. In the late 19th century, when...

Cloacal anomaly is a rare malformation with an incidence of 1 in 50,000 births. The definitive prenatal diagnosis of cloacal dysgenesis sequence is difficult. The use of three-dimensional (3-D) ultrasonography helps to describe the perineum and change diagnosis. In our case report, a large median genital structure was visualized, which was initially considered a penis-like structure, but the 3-D technique showed an enlarged bud. The urethral meatus was at the tip of this smooth structure. The lack of anal structure was clearly demonstrated.

Melanosis Coli is described as black or brown discoloration of the mucosa of the colon. It is a benign condition, whicharises from anthraquinone laxative abuse and usually has no symptoms of its own. Though not a very rare condition,to the best of our knowledge, no case has been reported on melanosis coli in Bangladesh . Here we report a case ofmiddle aged lady presenting with passage of blood mixed stool for one year. Colonoscopy was performed whichrevealed melanosis coli and which was later confirmed by histopathology. Not thought to be a pre malignantcondition, it has been found in some patients with other diseases.Keywords: Melanosis coli; Anthraquinone; Lipofuscin; Laxative; BangladeshDOI: 10.3329/jom.v11i2.5469J MEDICINE 2010; 11 : 183-185