Cloacal Malformation

Etiology:
— Common channel for genital and genitourinary and gastrointestinal systems
— Results from failure of separation between anorectal and urogenital channels early in gestation
Imaging – Initial imaging assessment:
— If hydrocolpos is suspected, perform renal US at birth as hydrocolpos can compress bladder causing obstructive uropathy requiring urgent surgical intervention with decompression of hydrocolpos
— Imaging of spinal anomalies
Imaging – Delayed imaging assessment:
— Cloacagram can be helpful in delineating the common channel which guides surgical intervention
DDX:
Complications:
Treatment: Surgical
Clinical:
— Definitive diagnosis made with physical exam that demonstrates one perineal opening for vagina and urethra and rectum

Radiology Cases of Cloacal Malformation

Lateral view (left) from a colostogram (lower left contrast collection) shows a rectovesical fistula with contrast filling the patient’s bladder (upper left contrast collection). Oblique view from later in the study (right) shows a filled bladder with a competent bladder neck, a long urethra-urogenital sinus and possibly a rudimentary vagina.

VCUG showing a cloacal malformation — Lateral image from a voiding cystourethrogram exam performed through a suprapubic tube shows a contrast filled bladder (to the left), retrograde filling of the colon (to the right), and incidental vesicoureteral reflux into a non-dilated ureter (in the middle). The patient is also voiding and the contrast filled urethra is seen to join into a common channel with the colon and the contrast flows through the common channel before it exits the body.

Fluoroscopic exam of cloacal malformation — AP (above left) and lateral (above right) images during injection of water soluble contrast into the vagina shows a dilated vagina and a duplicated uterus. Lateral image during antegrade injection of water soluble contrast into the patient’s distal mucous fistula (below left) shows a connection between the posteriorly located distal rectum and the posterior aspect of the vagina. Lateral image obtained during filling of the anteriorly located bladder with water soluble contrast through a suprapubic catheter (below right) shows the proximal urethra just inferior to the bladder to be dilated.

Clinical Cases of Cloacal Malformation

Clinical image of cloacal malformation — Clinical images show female external genitalia with no anus (left) and a single perineal orifice between the labia (right).