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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1807238
Review Article

Imaging in Cloacal Malformations: A Comprehensive Update with Insights into Management and Surgical Considerations

Abhinav C. Bhagat 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Radha Sarawagi 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Sneha Periyasamy
2   Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
,
Pramod K. Sharma 
3   Department of Paediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Rajesh Malik
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Aman Kumar
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Jitendra Sharma 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Ankur Patel
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
› Institutsangaben Funding None.
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Abstract

Cloacal malformations are a rare and complex group of anomalies resulting from faulty or incomplete separation of female genitourinary and anorectal systems. These encompass a wide spectrum of anomalies with varied clinical features, radiological imaging findings, and surgical management. They are frequently associated with spinal, cardiac, and respiratory tract abnormalities. Multidisciplinary teamwork is essential for achieving the best possible outcome in these patients. This article aims to provide a comprehensive analysis of cloacal malformations with review of current literature and discussion of relevant embryology, highlighting various classification systems and describing the role of imaging in diagnosis and preoperative planning, along with insights into management and surgical options.

Keywords

cloaca - common channel - MRI - fluoroscopy - PSARP


Publikationsverlauf

Artikel online veröffentlicht:
10. April 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Karlin G, Brock W, Rich M, Peña A. Persistent cloaca and phallic urethra. J Urol 1989; 142 (04) 1056-1059
    CrossrefPubMedSuche in Google Scholar
  • 2 Jacobs SE, Tiusaba L, Al-Shamaileh T. et al. Fetal and newborn management of cloacal malformations. Children (Basel) 2022; 9 (06) 888
    PubMedSuche in Google Scholar
  • 3 Jo Mauch T, Albertine KH. Urorectal septum malformation sequence: insights into pathogenesis. Anat Rec 2002; 268 (04) 405-410
    PubMedSuche in Google Scholar
  • 4 Williams IV DH, Fitchev P, Policarpio-Nicolas ML, Wang E, Brannigan RE, Crawford SE. Urorectal septum malformation sequence. Urology 2005; 66 (03) 657
    PubMedSuche in Google Scholar
  • 5 Gupta A, Bischoff A. Pathology of cloaca anomalies with case correlation. Semin Pediatr Surg 2016; 25 (02) 66-70
    PubMedSuche in Google Scholar
  • 6 Thomas DFM. The embryology of persistent cloaca and urogenital sinus malformations. Asian J Androl 2020; 22 (02) 124-128
    PubMedSuche in Google Scholar
  • 7 Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol 2019; 49 (03) 387-398
    PubMedSuche in Google Scholar
  • 8 Fayard C, Blondiaux E, Grigorescu R, Garel C. AIRP best cases in radiologic-pathologic correlation: prenatal and postmortem imaging of a complex cloacal malformation. Radiographics 2014; 34 (07) 2056-2063
    PubMedSuche in Google Scholar
  • 9 Kruepunga N, Hikspoors JPJM, Mekonen HK. et al. The development of the cloaca in the human embryo. J Anat 2018; 233 (06) 724-739
    PubMedSuche in Google Scholar
  • 10 Reck-Burneo CA, Vilanova-Sanchez A, Wood RJ, Levitt MA, Bates DG. Imaging in anorectal and cloacal malformations. Pediatr Radiol 2018; 48 (03) 443-444
    PubMedSuche in Google Scholar
  • 11 Peña A, Levitt MA, Hong A, Midulla P. Surgical management of cloacal malformations: a review of 339 patients. J Pediatr Surg 2004; 39 (03) 470-479 , discussion 470–479
    PubMedSuche in Google Scholar
  • 12 Levitt MA, Peña A. Cloacal malformations: lessons learned from 490 cases. Semin Pediatr Surg 2010; 19 (02) 128-138
    CrossrefPubMedSuche in Google Scholar
  • 13 Wood RJ, Reck-Burneo CA, Dajusta D. et al. Erratum to “Cloaca reconstruction: a new algorithm which considers the role of urethral length in determining surgical planning” [YJPSU 53/1 (2018) 90-95]. J Pediatr Surg 2018; 53 (03) 582-583
    PubMedSuche in Google Scholar
  • 14 AbouZeid AA, Mohammad SA. The cloacal anomalies: anatomical insights through a complex spectrum. J Pediatr Surg 2019; 54 (10) 2004-2011
    CrossrefPubMedSuche in Google Scholar
  • 15 Wood RJ, Reck-Burneo CA, Levitt MA. Cloacal malformations: technical aspects of the reconstruction and factors which predict surgical complexity. Front Pediatr 2019; 7: 240
    CrossrefPubMedSuche in Google Scholar
  • 16 Jaramillo D, Lebowitz RL, Hendren WH. The cloacal malformation: radiologic findings and imaging recommendations. Radiology 1990; 177 (02) 441-448
    PubMedSuche in Google Scholar
  • 17 Westgarth-Taylor C, Westgarth-Taylor T, Wood RJ, Levitt MA. Imaging in anorectal malformations: what does the surgeon need to know?. S Afr J Rad 2015; 19 (02) 10
    Suche in Google Scholar
  • 18 Bischoff A. The surgical treatment of cloaca. Semin Pediatr Surg 2016; 25 (02) 102-107
    CrossrefPubMedSuche in Google Scholar
  • 19 Abouzeid AA, Mohammad SA, Elsherbeny M. et al. Preoperative grading of sacrococcygeal teratoma: a roadmap to successful resection. J Neonatal Surg 2017; 6: 75-81
    CrossrefSuche in Google Scholar
  • 20 AbouZeid AA, Radwan AB, Eldebeiky M. et al. Persistent cloaca: persistence of the challenge. Ann Pediatr Surg 2020; 16: 3
    CrossrefSuche in Google Scholar
  • 21 Bischoff A, Levitt MA, Breech L, Hall J, Peña A. Vaginal switch: a useful technical alternative to vaginal replacement for select cases of cloaca and urogenital sinus. J Pediatr Surg 2013; 48 (02) 363-366
    PubMedSuche in Google Scholar
  • 22 Peña A. Total urogenital mobilization: an easier way to repair cloacas. J Pediatr Surg 1997; 32 (02) 263-267 , discussion 267–268
    CrossrefPubMedSuche in Google Scholar
  • 23 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
    CrossrefPubMedSuche in Google Scholar
  • 24 Riccabona M, Lobo ML, Ording-Muller LS. et al. European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part IX: imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminology. Pediatr Radiol 2017; 47 (10) 1369-1380
    PubMedSuche in Google Scholar
  • 25 Bhagat AC, Gupta RS, Malik R. Antenatal diagnosis of hydrometrocolpos with Mullerian duplication on ultrasound and fetal MRI: case report and literature review. BJR Case Rep 2023; 9 (03) 20230024
    PubMedSuche in Google Scholar
  • 26 Bischoff A, Levitt MA, Lim FY, Guimarães C, Peña A. Prenatal diagnosis of cloacal malformations. Pediatr Surg Int 2010; 26 (11) 1071-1075
    PubMedSuche in Google Scholar
  • 27 Peiro JL, Scorletti F, Sbragia L. Prenatal diagnosis of cloacal malformation. Semin Pediatr Surg 2016; 25 (02) 71-75
    CrossrefPubMedSuche in Google Scholar
  • 28 Chen CP, Chang TY, Hsu CY. et al. Persistent cloaca presenting with a perineal cyst: prenatal ultrasound and magnetic resonance imaging findings. J Chin Med Assoc 2012; 75 (04) 190-193
    PubMedSuche in Google Scholar
  • 29 Lin X, Xu X, Yang Y, Wu J, Xian X, Chen X. Preoperative evaluation of persistent cloaca using contrast-enhanced ultrasound in an infant. Med Ultrason 2020; 22 (02) 250-252
    PubMedSuche in Google Scholar
  • 30 Holschneider AM, Sharbatke H. Persistent cloaca-clinical aspects. In: Hutson JM, Holschneider AM. eds. Anorectal Malformations in Children. Berlin: Springer, Verlag; 2006: 201-209
    Suche in Google Scholar
  • 31 Li Y, Baskin S. L. 3D Fluoroscopic imaging facilitates reconstruction of common urogenital sinus and cloacal anomalies. Insight Urol 2022; 43 (02) 159-166
    Suche in Google Scholar
  • 32 Patel MN, Racadio JM, Levitt MA, Bischoff A, Racadio JM, Peña A. Complex cloacal malformations: use of rotational fluoroscopy and 3-D reconstruction in diagnosis and surgical planning. Pediatr Radiol 2012; 42 (03) 355-363
    PubMedSuche in Google Scholar
  • 33 Stafrace S, Lobo L, Augdal TA. et al. Imaging of anorectal malformations: where are we now? Abdominal imaging task force of the European Society of Paediatric Radiology. Pediatr Radiol 2022; 52 (09) 1802-1809
    CrossrefPubMedSuche in Google Scholar
  • 34 Halleran DR, Thompson B, Fuchs M. et al. Urethral length in female infants and its relevance in the repair of cloaca. J Pediatr Surg 2019; 54 (02) 303-306
    PubMedSuche in Google Scholar
  • 35 Mohammad SA, Abouzeid AA. MRI of persistent cloaca: can it substitute conventional imaging?. Eur J Radiol 2013; 82 (02) 241-251
    CrossrefPubMedSuche in Google Scholar
  • 36 McHugh K. The role of radiology in children with anorectal anomalies; with particular emphasis on MRI. Eur J Radiol 1998; 26 (02) 194-199
    PubMedSuche in Google Scholar
  • 37 Aslam A, Grier DJ, Duncan AW, Spicer RD. The role of magnetic resonance imaging in the preoperative assessment of anorectal anomalies. Pediatr Surg Int 1998; 14 (1–2): 71-73
    PubMedSuche in Google Scholar
  • 38 Nievelstein RA, Vos A, Valk J, Vermeij-Keers C. Magnetic resonance imaging in children with anorectal malformations: embryologic implications. J Pediatr Surg 2002; 37 (08) 1138-1145
    PubMedSuche in Google Scholar
  • 39 Nievelstein RA, Vos A, Valk J. MR imaging of anorectal malformations and associated anomalies. Eur Radiol 1998; 8 (04) 573-581
    PubMedSuche in Google Scholar
  • 40 Wang Z, Wu H, Wang Y. et al. Measuring the common canal of a persistent cloaca: can MRI replace conventional imaging?. Clin Radiol 2019; 74 (06) 488.e9-488.e15
    Suche in Google Scholar
  • 41 Podberesky DJ, Towbin AJ, Eltomey MA, Levitt MA. Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am 2013; 21 (04) 791-812
    PubMedSuche in Google Scholar