Patient Case Discussion
Case Summary
OVERVIEW
This was a case of an anorectal malformation in a female infant, which was initially misdiagnosed because of difficulties in placing the Foley. The infant was later diagnosed with a cloaca type one with a short common channel and underwent a planned PSARVUP, which confirmed the diagnosis. Postoperative care included bacitracin for 5 days, double diapering for a month, and a follow-up appointment 2 weeks postoperatively to start dilations, with the plan to do dilations twice daily and increase each size of the Hagar every week.
Diagnosing Cloaca in Newborn Exams
The importance of diagnosing cloaca during newborn exams was discussed, emphasizing the need for a thorough physical examination to differentiate between rectoperineal, rectal vestibular, and cloaca diagnoses. Pediatric surgery cases like the one presented can lead to excellent patient outcomes. The importance of a proper physical examination to avoid complications and misdiagnoses was also discussed.
Anorectal Malformation in Female Infant
The infant was found to have no anus and was transferred to the hospital for further evaluation. Initial studies, including sacral X-rays, ultrasounds of the kidneys and spinal ultrasound, and an echo were conducted. The infant was then diagnosed with a rectovaginal fistula based on a distal colostogram. However, during the initial part of the case, there was difficulty in placing the Foley, leading to concerns about the diagnosis. Further examination under anesthesia revealed a cloaca type one with a short common channel. The infant then underwent a planned PSARVUP, which confirmed the diagnosis. Because of the short common channel and the distance of the anatomy to the perineum, a posterior sagittal approach only was used. The infant's postoperative care included bacitracin for 5 days, double diapering for a month, and a follow-up appointment 2 weeks postoperatively to start dilations. The plan was to do dilations twice daily, increase each size of the Hagar every week, and then the infant will be a candidate for colostomy closure when she reaches her final dilator size, typically about 4 to 6 weeks after starting dilations.