Open Access
CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e63-e67
DOI: 10.1055/s-0044-1791814
Case Report

A Modification of the Newborn Operation for Cloacal Exstrophy: Leaving the Cecal Plate Untouched

Elizaveta Bokova 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Shimon E. Jacobs 
2   Department of Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Laura Tiusaba 
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Christina P. Ho
4   Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
,
Briony K. Varda
5   Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
,
Hans G. Pohl
4   Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
,
Christina Feng
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Victoria A. Lane
6   Department of Paediatric Surgery, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
,
Caitlin A. Smith
7   Department of Pediatric and Thoracic General Surgery, Seattle Children's Hospital, Seattle, Washington, United States
,
Andrea T. Badillo
8   Department of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Richard J. Wood
9   Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Marc A. Levitt
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
› Institutsangaben
Funding None.
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Abstract

The conventional approach to managing a newborn with cloacal exstrophy typically includes separating the cecal plate from between the two hemibladders, tubularizing it to be included in the fecal stream, creating an end colostomy, and bringing the two bladder halves together. This study introduces an alternative approach wherein the cecal plate is retained in its original position and designated for future use as an autoaugment of the bladder. Four cases of cloacal exstrophy cases managed between November 2019 and February 2024 are described, with surgical approach and postoperative outcomes reported. Two patients who underwent traditional reconstruction experienced bacterial overgrowth attributed to stasis in the cecal plate, which manifested in increased ostomy output and feeding intolerance. Treatment in these two cases was to remove the cecum from the fecal stream and use it instead for a bladder augment. Learning from these cases, the third and fourth newborn's approach involved retaining the cecum in situ for autoaugmentation of the bladder and performing an ileal to hindgut anastomosis. No postoperative acidosis occurred in these patients. The alternative approach to the newborn management of cloacal exstrophy whereby the cecal plate is left in situ can decrease stasis and postoperative bacterial overgrowth. It allows for an autoaugmentation of the bladder and is technically easier than the traditional rescue of the cecal plate from within the two hemibladders.

Keywords

cloaca - cloacal exstrophy - cecum - bladder augmentation - reconstruction


Publikationsverlauf

Eingereicht: 05. April 2024

Angenommen: 01. August 2024

Artikel online veröffentlicht:
21. Oktober 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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