Within the field of pediatric colorectal and pelvic reconstruction, the most complex anatomic problem a pediatric surgeon can face is that of a cloacal malformation. The urinary tract, gynecologic system, and distal bowel all fuse into a single common channel which must be surgically reconstructed. The care of patients with a cloaca is daunting, and the spectrum of anatomic variations very wide. In this book about cloaca, the authors have brought organization to the complex, providing basic principles of care, from fetal and newborn management to the reconstruction of bowel, gynecologic systems, and urinary tracts as well as the care of patients after surgery to puberty and beyond.
This is a comprehensive account of all elements of care for the cloaca patient. It includes preoperative evaluation and surgical planning, the anorectal malformation (ARM) index, surgical reconstruction, urological evaluation and long-term care. Also covered are the gynecologic evaluation and intervention, neurological implications, bowel management and the long-term management of patients with cloacal malformations. Case studies provide valuable insights into a wide range of clinical scenarios, never previously categorized so comprehensively. These studies enable the reader to understand and gain experience from detailed descriptions. Fully illustrated, in color, and with further resources available online, this is a unique resource for all clinicians within the pediatric team caring for patients with cloacal malformations.
In addition, specialists across numerous fields, including colorectal surgery, urology, gynecology, and gastrointestinal motility, as well as neonatology, orthopedics, neurosurgery, anesthesia, radiology, psychology, social work, nutrition, and nursing, will find this practical clinical text and its online resources to be an invaluable when dealing with the complex needs of the cloaca patient.
Part One: Overview
1. History of Cloacal Malformations
Tamador Al-Shamaileh, Marc A. Levitt
2. Overview of Cloacal Malformations
Tamador Al-Shamaileh, Andrea T. Badillo, Marc A. Levitt
3. Preoperative Evaluation and Surgical Planning
Tamador Al-Shamaileh, Allison C. Mayhew, Briony K. Varda, Marc A. Levitt
4. The ARM Index
Andrea T. Badillo, Briony K. Varda, Marc A. Levitt
5. Surgical Reconstruction
Tamador Al-Shamaileh, Allison C. Mayhew, Briony K. Varda, Marc A. Levitt
6. Urological Evaluation and Long-Term Management in Cloacal Malformations
Briony K. Varda, Tamador Al-Shamaileh, Marc A. Levitt
7. Gynecologic Evaluation and Intervention in Cloacal Malformations
Allison C. Mayhew
8. Neurosurgical Implications
John Myseros
9. Bowel Management
Kristina Booth, Stephanie Vyrostek, Katie Worst, Marc A. Levitt
10. Long-Term Outcomes of Patients with Cloacal Malformations
Tamador Al-Shamaileh, Briony K. Varda, Marc A. Levitt
Part Two: Case Studies
Case 1 A patient with a prenatal diagnosis of a cloacal malformation
Andrea T. Badillo, Tamador Al-Shamaileh, Briony K. Varda, Marc A. Levitt
Section 1 Total Urogenital Mobilization (TUM)
Case 2 TUM in a patient with a cloacal malformation and borderline common channel and urethral lengths
Laura Tiusaba, Briony K. Varda, Tamador Al-Shamaileh, Marc A. Levitt
Case 3 A patient with a cloacal malformation, a short channel, and a high rectum
Teresa L. Russell, Christina Feng, Tamador Al-Shamaileh, Marc A. Levitt
Case 4 A patient with a cloacal malformation, a short common channel, and a tethered cord
Laura Tiusaba, Briony K. Varda, Tamador Al-Shamaileh, Marc A. Levitt
Section 2 Urogenital (UG) Separation
Case 5 UG Separation vs. TUM in a patient with a borderline cloacal malformation who underwent a UG separation
Teresa L. Russell, Tamador Al-Shamaileh, Marc A. Levitt
Case 6 A patient with a cloacal malformation, a long common channel, and a high rectum
Tamador Al-Shamaileh, Elizaveta Bokova, Marc A. Levitt
Case 7 A patient with a cloacal malformation, a long common channel, and a long urethra
Shimon E. Jacobs, Christina Feng, Tamador Al-Shamaileh, Marc A. Levitt
Case 8 A patient with a cloacal malformation, a short common channel, and a short urethra
Richard J. Wood
Case 9 Laparoscopic approach to a patient with a cloacal malformation
Prathima Nandivada, Erin McNamara, Belinda Dickie
Section 3 Special Cases
Case 10 A patient with a cloacal malformation and a slightly hypospadic urethral meatus (Cloacal type 1)
Tamador Al-Shamaileh, Marc A. Levitt
Case 11 A patient with a cloacal malformation, a rectourethral fistula, and distal vaginal atresia
Teresa L. Russell, Tamador Al-Shamaileh, Allison C. Mayhew, Marc A. Levitt
Case 12 A patient with a cloacal malformation with urethral atresia
Tamador Al-Shamaileh, Elizaveta Bokova, Marc A. Levitt
Case 13 A patient with a posterior cloacal variant: a urogenital sinus with perineal fistula
Shimon E. Jacobs, Tamador Al-Shamaileh, Marc A. Levitt
Case 14 A patient with a cloacal malformation, Mullerian anomalies, and vesicoureteral reflux
Athanasios Tyraskis, Laura Tiusaba, Shimon Jacobs, Allison C. Mayhew, Marc A. Levitt
Case 15 A patient with cloacal exstrophy
Laura Tiusaba, Caitlin Smith, Briony K. Varda
Case 16 Bowel management in a patient with cloacal malformation
Kristina Booth, Stephanie Vyrostek, Katie Worst, Marc A. Levitt
Appendices
Appendix A Treatment Timeline for Patients with Cloacal Malformations
Tamador Al-Shamaileh, Marc A. Levitt
Appendix B Cloacagram
Tamador Al-Shamaileh, Marc A. Levitt
Appendix C Examination Under Anesthesia Sample Operative Note
Tamador Al-Shamaileh, Marc A. Levitt
Appendix D Electrical Stimulation of the Anus
Tamador Al-Shamaileh, Marc A. Levitt
Appendix E Operating Room Preparation
Tamador Al-Shamaileh, Marc A. Levitt
Appendix F Postoperative Care Instructions
Tamador Al-Shamaileh, Marc A. Levitt
Appendix G Applied Anatomy
Teresa L. Russell, Tamador Al-Shamaileh, Marc A. Levitt
Appendix H New Gynecologic Anatomic Diagrams
Allison C. Mayhew
Biography
Marc A. Levitt focuses his career on enhancing the care of children with colorectal and pelvic reconstructive needs. He has cared for children from all 50 of the United States and from over 75 countries and has performed more than 15,000 pediatric colorectal procedures. He has written four textbooks and this is his fifth, as well as over 300 scientific articles in this subject area. His work extends to educating students, surgeons, other medical colleagues, and nurses, as well as developing integrated centers throughout the world to ensure that all children have access to quality colorectal care. He is actively engaged in helping patients, their doctors, and nurses in resource limited locations through the organization Colorectal Team Overseas, www.ctoverseas.org. He is the Chief of the Division of Colorectal and Pelvic Reconstruction at Children’s National Hospital, in Washington DC, a uniquely integrated team of pediatric colorectal surgeons, urologists, gynecologists, gastroenterologists, and nurses and is a Professor of Surgery and Pediatrics at The George Washington University School of Medicine.
Associate Editors
Tamador Al-Shamaileh, MD
Pediatric Surgery Consultant
Assistant Professor, Department of General Surgery, Faculty of Medicine
Mu’tah University, Al-Karak, Jordan
University of Jordan, Amman, Jordan
Andrea T. Badillo, MD
Director, Division of Colorectal and Pelvic Reconstruction, Pediatric Surgeon,
Divisions of Colorectal and Pelvic Reconstruction and General and Thoracic Surgery, and Program Director, Pediatric Colorectal Fellowship, Department of Surgery
Children’s National Hospital, Washington, DC, USA
Associate Professor of Surgery and Pediatrics,
The George Washington University School of Medicine
Allison C. Mayhew, MD
Director, Pediatric and Adolescent Gynecology,
Pediatric and Adolescent Gynecologist,
Division of Colorectal and Pelvic Reconstruction, Department of Surgery
Children’s National Hospital, Washington, DC, USA
Assistant Professor of Gynecology,
The George Washington University School of Medicine
Teresa L. Russell, MS
Senior Clinical Research Coordinator,
Divisions of Urology and Colorectal and Pelvic Reconstruction, Department of Surgery
Children’s National Hospital, Washington, DC, USA
Briony K. Varda, MD, MPH
Co-Director, Children’s National Spina Bifida Program,
Divisions of Urology and Colorectal and Pelvic Reconstruction, Department of Surgery
Children’s National Hospital, Washington, DC, USA
Assistant Professor of Urology and Pediatrics,
The George Washington University School of Medicine
Richard J. Wood, MD
Chief, Department of Pediatric Colorectal and Pelvic Reconstructive Surgery,
Nationwide Children’s Hospital, Columbus, OH, USA
Professor of Surgery,
The Ohio State University, Columbus, OH, USA
