Cloacal exstrophy: morbidity associated with abnormalities of the gastrointestinal tract and spine.
OBJECTIVE
The aim of this study was to review the management of the gastrointestinal tract in cloacal exstrophy and to assess the effect of spinal dysraphism on nutritional outcome.


METHODS
Twenty-two patients with cloacal exstrophy were reviewed retrospectively. Gastrointestinal and spinal anomalies were documented. The need for nutritional supplementation was recorded. Weights at 1 and 5 years of age were used to assess growth in childhood.


RESULTS
Ten patients were treated initially with ileostomy, 7 with colostomy, and 3 without stoma. Two patients died before surgical reconstruction. Total parenteral nutrition (TPN) was utilized in 8 infants for a median of 10 days (range, 5 to 200). Three patients had complications with colostomies requiring conversion to ileostomy. Patients with an ileostomy required more nutritional supplementation compared with patients with a colostomy (50% v 28%). High-output stoma losses were more common in patients with an ileostomy (40% v 14%). Fourteen patients (67%) with spinal dysraphism had a higher incidence of failure to thrive in the first year of life (69% v 26%) and multiple episodes of enteritis (40% v 25%). Two neonates with duodenal atresia and small bowel deletion died within the first month of life. One patient with short bowel syndrome died of TPN-associated liver disease at 6 months of age. There were no other deaths.


CONCLUSIONS
The gastrointestinal tract contributes significantly to the morbidity and mortality in cloacal exstrophy. Nutritional supplementation is more frequently required in patients with an ileostomy. Stoma complications were higher in those with a colostomy. Morbidity is high in patients with spinal dysraphism.
McHoney
Merrill
M
Department of Paediatric Urology, Great Ormond Street Hospital for Children, Institute of Child Health, London, England, UK.
Ransley
Phillip G
PG
Duffy
Patrick
P
Wilcox
Duncan T
DT
Spitz
Lewis
L
D000015:Abnormalities, Multiple / Q000601:surgery; D001835:Body Weight; D002988:Cloaca / Q000002:abnormalities* / Q000601:surgery; D003125:Colostomy; D004065:Digestive System Abnormalities / Q000150:complications* / Q000601:surgery; D004380:Duodenal Obstruction / Q000151:congenital; D004751:Enteritis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007081:Ileostomy; D007231:Infant, Newborn; D007409:Intestinal Atresia / Q000401:mortality; D008286:Malabsorption Syndromes / Q000209:etiology* / Q000628:therapy; D008297:Male; D018529:Nutritional Support; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000209:etiology / Q000401:mortality; D016135:Spinal Dysraphism / Q000150:complications* / Q000601:surgery; D014564:Urogenital Abnormalities / Q000150:complications / Q000601:surgery