What is the role of surgery in the treatment of cloacal exstrophy?

Updated: Nov 05, 2019
  • Author: James G Glasser, MD, MA, FACS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Answer

Repair of cloacal exstrophy includes the following:

  • Reduction of the prolapsed ileum (the "elephant trunk")

  • Separation of the flayed-open cecum from the central portion of the bifid bladder; this placode of cecum is tubularized

  • Approximation and repair of the bladder halves as in bladder exstrophy

  • Later, mobilization and anastomosis of the colostomy to the rudimentary hind gut and creation of a stoma; or an anus may be reconstructed by posterior sagittal anorectoplasty [58]

See the images below.

Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). This photograph shows cloacal exstrophy in an infant.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Note the bifid genitalia in this infant with cloacal exstrophy.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). In the repair of cloacal exstrophy, the cecal plate in the middle of the bifid bladder is excised and used to create an ostomy, and the bladder halves are approximated.
Pediatric omphalocele and gastroschisis (abdominal Pediatric omphalocele and gastroschisis (abdominal wall defects). Closure of the bladder exstrophy is shown.

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