Persistent cloaca and caudal duplication in a monovular twin, a rare case report
AffiliationUniv Arizona, Coll Med
Univ Arizona, Div Neonatol
Univ Arizona, Steele Childrens Res Ctr
Univ Arizona, Diamond Childrens Med Ct
MetadataShow full item record
PublisherELSEVIER SCI LTD
CitationCohen, Naomi & Nagy Ahmed, Mohamed & Goldfischer, Rachelle & Zaghloul, Nahla. (2019). Persistent cloaca and caudal duplication in a monovular twin, a rare case report. International Journal of Surgery Case Reports. 60. 10.1016/j.ijscr.2019.06.013.
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AbstractINTRODUCTION: 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. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
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