Download PDF
CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e26-e32
DOI: 10.1055/a-2204-8629
Case Report

Posterior Sinuplasty: A New Strategy for Managing Hydrocolpos in Cloaca—Case Series

Amr AbdelHamid AbouZeid 
1   Department of Pediatric Surgery, Ain Shams University Faculty of Medicine, Cairo, Egypt
,
Ahmed Saad Abdelmoniem
2   Department of Pediatric Surgery, Benha Health Insurance Hospital, Benha, Egypt
,
Mohamed Abdelrahman Fathy
3   Department of Pediatric Surgery, Minia University, El Minia, Egypt
,
Mohamed Ahmed Negm
4   Department of Pediatric Surgery, South Valley University Qena Faculty of Medicine, Qena, Egypt
,
Shaimaa Abdelsattar Mohammad
5   Department of Radiodiagnosis, Ain Shams University Faculty of Medicine, Cairo, Egypt
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

We present a simple surgical technique aiming to improve urine outflow through the common urogenital sinus in cloaca and facilitate drainage of existing hydrocolpos. The study included three cases of cloaca with associated hydrocolpos that were operated during the period 2022 through 2023. The patient is placed in the prone position for a standard posterior sagittal anorectoplasty. The distal rectal fistula is severed flush with the vagina/sinus leaving an open defect in the posterior wall of the vagina/sinus. The defect is then widened distally via a vertical incision (∼1 cm) through the posterior wall of the common urogenital sinus toward but not reaching the perineum. This vertical defect is then closed horizontally displacing the posterior vaginal wall downwards toward the perineum (posterior sinuplasty). The postoperative recovery was uneventful in the three cases. Adequate drainage of hydrocolpos was confirmed by imaging at follow-up, as well as improvement of upper urinary tract dilatation. In selected cases of cloaca, posterior sinuplasty is a simple procedure that can be applied during anorectoplasty to provide effective drainage of associated hydrocolpos.

Keywords

anorectal malformations - urogenital sinus - vaginal septum - Mullerian anomalies - congenital


Publication History

Received: 17 July 2023

Accepted: 21 October 2023

Accepted Manuscript online:
06 November 2023

Article published online:
13 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bischoff A. The surgical treatment of cloaca. Semin Pediatr Surg 2016; 25 (02) 102-107
    Google Scholar
  • 2 Versteegh HP, van Rooij IA, Levitt MA, Sloots CE, Wijnen RM, de Blaauw I. Long-term follow-up of functional outcome in patients with a cloacal malformation: a systematic review. J Pediatr Surg 2013; 48 (11) 2343-2350
    Google Scholar
  • 3 Leclair MD, Gundetti M, Kiely EM, Wilcox DT. The surgical outcome of total urogenital mobilization for cloacal repair. J Urol 2007; 177 (04) 1492-1495
    Google Scholar
  • 4 Caldwell BT, Wilcox DT. Long-term urological outcomes in cloacal anomalies. Semin Pediatr Surg 2016; 25 (02) 108-111
    Google Scholar
  • 5 Fernando MA, Creighton SM, Wood D. The long-term management and outcomes of cloacal anomalies. Pediatr Nephrol 2015; 30 (05) 759-765
    Google Scholar
  • 6 Peña A. Total urogenital mobilization–an easier way to repair cloacas. J Pediatr Surg 1997; 32 (02) 263-267 , discussion 267–268
    Google Scholar
  • 7 AbouZeid AA, Mohammad SA. The cloacal anomalies: anatomical insights through a complex spectrum. J Pediatr Surg 2019; 54 (10) 2004-2011
    Google Scholar
  • 8 Levitt MA, Peña A. Cloacal malformations: lessons learned from 490 cases. Semin Pediatr Surg 2010; 19 (02) 128-138
    Google Scholar
  • 9 deVries PA, Peña A. Posterior sagittal anorectoplasty. J Pediatr Surg 1982; 17 (05) 638-643
    Google Scholar
  • 10 AbouZeid AA, Radwan AB, Eldebeiky M, Hay SA. Persistent cloaca: persistence of the challenge. Ann Pediatr Surg 2020; 16: 3
    Google Scholar
  • 11 Levitt MA, Bischoff A, Peña A. Pitfalls and challenges of cloaca repair: how to reduce the need for reoperations. J Pediatr Surg 2011; 46 (06) 1250-1255
    Google Scholar
  • 12 Hendren WH. Urogenital sinus and anorectal malformation: experience with 22 cases. J Pediatr Surg 1980; 15 (05) 628-641
    Google Scholar