Fecal continence following an anterior-sagittal ano-enteroplasty in a patient with cloacal exstrophy.
A two-year-old Latin American female was referred for treatment of what appeared to be a straightforward case of cloacal exstrophy. At operation, incision along the superior margin of the exstrophic bladder allowed identification of an unusual variant of exstrophy which consisted of bladder exstrophy; erminal colon duplication, the common medial wall of which protruded 8 cm beyond the end of the bowel lumen, and which exited ventrally and immediately caudad to the exstrophic bladder; an enteric diverticulum at the superior rim of the bladder; and two small vaginae, existing laterally on either side, at the junction between the bladder and the terminal bowel. The terminal bowel was mobilized, the duplications were excised, and a tapering enteroplasty was performed. Despite a flat-appearing bottom, a posterior muscle complex was identified which extended anterolaterally and attached to the pubis on either side. Following observation of an appropriate response to electrical stimulation, the muscle complex was partially divided in the midline, from anterior to posterior, just enough to make room for the tapered bowel. The muscle was then reapproximated in the midline anteriorly, surrounding the bowel, and an anoplasty was constructed. The bladder was closed, and the pubic rami were wired together (bilateral posterior iliac osteotomies were performed at the beginning of the operation). One and 1/2 years following this procedure, the child has a normal "rectal" exam with a palpable sphincter. She has 3 to 4 solid bowel movements daily without soiling, and she awaits genitourinary reconstruction.
D000015:Abnormalities, Multiple / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery*; D001746:Bladder Exstrophy / Q000601:surgery*; D002675:Child, Preschool; D003106:Colon / Q000002:abnormalities*; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D014621:Vagina / Q000002:abnormalities*