Cloacal malformation

Abstract

Rationale: Cloacal malformation (CM) is a serious type of anorectal and urogenital tract malformation. However, prenatal ultrasound (US) detection of CM is challenging. In this paper, we reported a rare case of CM prenatally diagnosed by US and magnetic resonance imaging (MRI), as well as reviewed the prenatal US and MRI characteristics of CM in the literature. Patient concerns: A 30-year-old pregnant woman complained of cystic mass in the fetal abdomen detected by prenatal US. Diagnosis: Fetus CM. Interventions: The fetus was diagnosed as fetal CM by US and MRI, then the pregnant woman received a drug-induced labor treatment. After the neonate was delivered, the measurement was performed on the weight, length, head circumference, abdomen circumference, and bilateral thigh circumference. Outcomes: A female dead neonate was delivered from the vagina of the gravida, showing congenital anus absence. Prenatal ultrasound demonstrated right kidney duplication, hydronephrosis, and right ureteral dilatation. Meanwhile, prenatal MRI showed a cystic cavity, double collecting systems of right kidney, right ureteral dilatation, and right rectum dilatation. In addition, general parameters are as follows: weight: 2280 g; length: 39 cm; head circumference: 26.3 cm; abdomen circumference: 31 cm; right thigh circumference: 17 cm, and left thigh circumference: 18 cm. Lessons: US combined with MRI can not only provide reliable evidence for fetal CM in the third trimester but also offer crucial information to the pregnant women to establish clinic treatment programs as early as possible.

Ultrasound and magnetic resonance imaging features of fetal urogenital anomalies: A pictorial essay

“…A higher T2 signal in the distal bowel signifies the existence of fluid, while a reduced T2 or a bright T1 signal indicates the accumulation of meconium in the bladder. These observations strongly suggest the presence of a fistula between the urinary and digestive systems 105–107 (Figure 10). Intraluminal calcifications can also be observed in cases of cloaca malformation, indicating the mixing of urine and meconium 105,108 …”

“…104 MRI results indicative of cloaca typically comprise distended distal bowel that does not extend beyond the bladder, absence of meconium signal at the anticipated rectal location, renal abnormalities (usually hydronephrosis), abnormal appearance of the bladder, and hydrocolpos. 102 strongly suggest the presence of a fistula between the urinary and digestive systems [105][106][107] (Figure 10). Intraluminal calcifications can also be observed in cases of cloaca malformation, indicating the mixing of urine and meconium.…”