Collection
Built automatically
From across the library
Not curated by a person
Cloacal Exstrophy
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Cloacal exstrophy is the most complex of all anatomic problems faced by the pediatric reconstructive surgeon. Cloacal Exstrophy: A Modification of the Newborn Operation - Leaving the Cecal Plate Untouched · 0:00
Cloacal Exstrophy: A Modification of the Newborn Operation - Leaving the Cecal Plate Untouched
Watch →
Pediatric Colorectal & Pelvic Reconstruction | Children's National Hospital (childrensnational.org)
video6:48 · Oct 2024
Spending extra time in the newborn period to reconstruct the hindgut and vagina can save significant work later, especially in patients whose anatomy allows for comprehensive reconstruction. — Payam Saadai, Colorectal Quiz Episode 33: Cloaca Exstrophy · 20:37
Colorectal Quiz Episode 33: Cloaca Exstrophy
Watch →
Dr. Payam Saadai joins Dr. Marc Levitt and Dr. Jason Frischer to discuss the management of cloacal exstrophy covering traditional, and newer techniques.
Don't forget to like and subscribe to see more entertaining medical educational videos
video22:24 · Jul 2026
Surgeons must accept that cloacal exstrophy is a spectrum and be prepared to deal with complex, variable colonic anatomy rather than taking the easy way out with an ileostomy. — Alberto Peña, Cloacal Exstrophy with Dr. Alberto Peña · 19:13
Cloacal Exstrophy with Dr. Alberto Peña
Listen →
Discussion between Dr. Alberto Pena and Dr. Todd Ponsky about cloaca exstrophy
podcast53:06 · Jan 2019
Cloacal Exstrophy with Dr. Alberto Peña
Listen →
Discussion between Dr. Alberto Pena and Dr. Todd Ponsky about cloaca exstrophyPodcast Discussion:What is cloacal exstrophy?A group of congenital diseases involving the lower gastrointestinal tract, urogenital tract, spine, and even the lowe
podcast53:06 · Dec 2020
Expert statements from the recordings in this collection.
Cloacal Exstrophy with Dr. Alberto Peña
Cloacal exstrophy is a spectrum of congenital malformations affecting the gastrointestinal/colorectal area, urogenital tract, spine and cord, and sometimes lower extremity motion.
Alberto Peña1:31
Babies with cloacal exstrophy are born with an omphalocele, bladder exstrophy (two separated hemibladders), open cecum between the hemibladders, and separated pubic bones.
Alberto Peña2:09
The small bowel can become exstrophic through the ileocecal valve, creating an 'elephant trunk' appearance.
Alberto Peña3:08
Male patients have two separated hemiphalluses with normal gonads; female patients have two hemivaginas below the exstrophic bladder leading to two hemiuteri.
Alberto Peña3:32
Cloacal exstrophy represents a spectrum of colonic anatomy from normal colon to almost absent or completely absent colon, sometimes with two ceca or two appendices and bizarre blood supply.
Alberto Peña4:20
The amount of colon present at birth has very important implications for the patient's management and outcomes.
Alberto Peña4:57
A variant exists where babies are born with intact abdominal skin (no omphalocele, no bladder exstrophy externally) but have a completely open bladder inside with no bladder neck and a single large perineal orifice.
Alberto Peña5:44
While surgical techniques, intensive care, parenteral nutrition, and metabolic management have improved, functional outcomes (bowel control, urinary control, sexual function, spinal abnormalities) remain severely limited and cannot be made normal.
Alberto Peña7:02
Historical practice was to perform bilateral gonadectomy, remove hemiphalluses, create a vagina with bowel, and assign female gender to XY patients with cloacal exstrophy.
Alberto Peña8:31
Patients raised as female despite XY chromosomes exhibited male attitudes and behavior, and many became upset upon learning their chromosomal sex and that gonads were removed without their consent.
Alberto Peña9:16
Patients argued that sex is not the most important aspect of being male, that they wanted their gonads back for fertility (modern techniques allow fertilization and children), and that being male is much more than having a phallus.
Current consensus is that XY patients should be raised as male, with pediatric urologists and plastic surgeons working on phallus reconstruction techniques.
When a prominent pediatric urologist dominates management, patients receive good urologic attention but inadequate gastrointestinal care; the reverse occurs when pediatric surgeons dominate.
Alberto Peña12:13
The pediatric surgeon's role in the initial operation is to close the omphalocele (if possible), separate urothelium from intestinal mucosa by placing stitches at the edges and making an incision, allowing the urologist to bring hemibladders together.
Alberto Peña13:03
It is very common but very harmful for pediatric surgeons to simply create an ileostomy, leaving all colon distally attached to the urinary tract.
Alberto Peña14:55
Leaving colon attached to the urinary tract creates a congenital bladder augmentation that causes hyperchloremic acidosis from urine absorption, interfering with growth and development.
Alberto Peña15:31
Defunctionalized colonic tissue left distally will not grow; colon requires passage of fecal matter through its lumen to grow.
Alberto Peña16:03
The pediatric surgeon must incorporate all gastrointestinal tissue into the fecal stream and create a true end colostomy to ensure fecal matter passes through all colonic tissue.
Alberto Peña16:23
Patients who received ileostomy with defunctionalized colon present at 2-3 years with poor growth, hyperchloremic acidosis managed by nephrologists, and large ileostomy losses.
Alberto Peña16:41
The rescue operation involves taking down the ileostomy, finding and incorporating colonic tissue into the GI tract, and creating an end colostomy; acidosis disappears the next day.
Alberto Peña17:03
Surgeons must accept that cloacal exstrophy is a spectrum and be prepared to deal with complex, variable colonic anatomy rather than taking the easy way out with an ileostomy.
Some institutions routinely perform pelvic osteotomy at the initial operation to facilitate bladder and omphalocele reconstruction, while others wait 2-3 months to do it separately.
Alberto Peña21:00
Even after osteotomy, it is very difficult to see a cloacal exstrophy patient with pubic bones completely together; they usually remain separated.
Alberto Peña21:09
Even a technically correct end colostomy often has poor motility, and babies may not pass stool easily, sometimes developing bacterial overgrowth similar to Hirschsprung disease.
Alberto Peña22:06
Families must be taught to irrigate the colostomy with small volumes of saline through a tube to evacuate fecal material when peristalsis is inadequate.
Alberto Peña23:00
Decision-making for bowel control begins around age 3 when parents want to send the child to school clean and dry (no stool or urine in diaper).
Alberto Peña23:30
Most cloacal exstrophy patients have an inadequate, tiny bladder requiring bladder augmentation with gastrointestinal tract, necessitating coordination between pediatric surgery and urology.
Alberto Peña23:54
Patients born with no colon are candidates for permanent colostomy and should never have terminal ileum pulled through, even if sphincter evidence exists, because they will never have bowel control.
Alberto Peña24:42
Pull-through is only considered for patients with capacity to form solid stool (adequate colon), as bowel management only works with solid stool.
Alberto Peña25:04
It is extremely unusual for cloacal exstrophy patients to have spontaneous bowel control; the overwhelming majority need a bowel management program (enema administration to keep patient clean).
Alberto Peña25:20