6½-Year-Old Female Patient Referred for Extensive Secondary Surgery of Her Cloacal Malformation (Hendren Patient Case)

• Patient at 42 years described her overall status as great!
• By age 7 years, she had urinary control but used daily enemas to evacuate the colon
• Urine and bowel control were complete at age 9
• At age 15 years, a right buttocks flap was inserted into the vagina to enlarge its caliber
• Flap base was replaced 6 months later
• Rectum was moved back a little to position it better in the sphincter muscles
• At age 18 years, a right lower quadrant mass necessitated through the abdominal wall
• The tube and ovary were removed
• Right uterus was later removed elsewhere.

Takeaways:

• This patient illustrates responsibility to plan wisely and thoroughly in dealing with complex malformations so that the patient can live a life of good quality
• In this baby, the original surgery had been ill conceived
• When she was 6, plans were made for permanent urinary diversion, until the family read in a lay magazine that undiversion was a possible course of action
• 20-hour operation she endured made that possible.
• Rare cases like cloacas should be triaged to a limited number of loci where experience can be maximized

Publications & Educational Resources
Urogenital Sinus and Anorectal Malformation: Experience with 22 Cases