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VACTERL Association
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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The vagina must be drained immediately in hydrocolpos, first attempting catheter placement confirmed by ultrasound, or creating a vaginostomy if catheterization fails or is inadequate. Fetal and Newborn Management of Cloacal Malformations · 7:50
Fetal and Newborn Management of Cloacal Malformations
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Fetal and Newborn Management of Cloacal MalformationsTune in as we explore the complex world of cloacal malformations, a rare congenital anomaly affecting female newborns. This episode breaks down the critical steps from prenatal diagnosis
podcast13:53 · Sep 2026
In patients with necrotizing enterocolitis, it is reasonable to get a contrast study before stoma takedown. — Todd, Journal of Pediatric Surgery Article Review: March 2023 · 10:15
Quick Literature Updates Episode 14
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We’re back with fourteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most int
video4:46 · Dec 2023
Journal of Pediatric Surgery Article Review: March 2023
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Weâre featuring Journal of Pediatric surgery articles this week to bring you some of the latest news! This week we are discussing three articles from the March
podcast11:42 · Jul 2026
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Fetal and Newborn Management of Cloacal Malformations
Cloacal malformations occur only in females with an incidence of approximately 1 in 50,000 births.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:21 ↗
In cloacal malformations, the GI tract, urinary system, and gynecologic tract all exit through a single opening due to failure of separation during development.
Host summaryThe host summarizing the discussion — not the host's own clinical position0:21 ↗
Abdominal or pelvic cystic masses are found on prenatal ultrasound in 52% of cloacal malformation cases.
epidemiological1:21 ↗
Hydronephrosis is seen on prenatal ultrasound in approximately 49% of cloacal malformation cases.
epidemiological1:32 ↗
Intraluminal calcifications are a specific prenatal ultrasound finding for cloacal malformations, forming when urine mixes with meconium inside the body, indicating communication between bowel and urinary tract.
clinical1:44 ↗
Up to 70% of non-syndromic cloacal malformation patients have VACTERL association.
epidemiological2:25 ↗
VACTERL association is defined as having 3 or more of the following: vertebral defects, anorectal malformations, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb defects.
clinical2:41 ↗
Vaginal delivery is often safe and feasible for cloacal malformations.
clinical4:02 ↗
Delivery must occur at a specialized tertiary care center with a top-level NICU and subspecialists available.
guideline4:07 ↗
Immediate postnatal priorities include stabilizing breathing and circulation, obtaining IV access, starting antibiotics, and ensuring urine and stool can exit the body.
guideline4:27 ↗
Initial NICU stay typically lasts 2 to 3 weeks for stabilization and early procedures.
clinical4:50 ↗
Definitive reconstructive surgery for cloacal malformations is usually performed between 3 and 12 months of age.
guideline4:57 ↗
Passing a nasogastric tube immediately after birth checks for esophageal atresia or tracheoesophageal fistula, which occurs in 7-11% of babies with anorectal malformations.
clinical5:22 ↗
Cardiac defects occur in up to 40% of cloacal malformation cases, requiring early echocardiogram before considering abdominal surgery.
epidemiological5:40 ↗
The proper physical examination technique for cloacal malformations requires gently lifting the labia edges upwards and outwards toward the examiner's shoulders to visualize the single small orifice.
clinical6:07 ↗
The common misdiagnosis error is identifying a cloacal malformation as a rectovaginal fistula; true rectovaginal fistulas are extremely rare.
clinical6:31 ↗
Hydrocolpos is found in up to one-third of cloacal malformation cases and can be lethal if not managed quickly.
clinical7:00 ↗
Hydrocolpos results from massive distention of the shared vaginal structure with trapped fluid (urine and mucus) when the single exit opening is inadequate.
clinical7:05 ↗
The distended vagina in hydrocolpos compresses the bladder, blocking both ureterovesical junctions and causing severe bilateral hydroureteronephrosis.
clinical7:25 ↗
The vagina must be drained immediately in hydrocolpos, first attempting catheter placement confirmed by ultrasound, or creating a vaginostomy if catheterization fails or is inadequate.
guideline7:50 ↗
Vaginal drainage must be performed before considering other urologic surgeries like vesicostomy or nephrostomy tubes, as the hydroureteronephrosis is caused by vaginal compression of the bladder.
guideline8:13 ↗
Over 80% of cloacal malformation patients have associated urinary tract anomalies.
epidemiological8:46 ↗
Vesicoureteral reflux (VUR) is seen in approximately 50% of cloacal malformation patients.
epidemiological8:51 ↗
Hydronephrosis occurs in 30% of cloacal malformation patients.
epidemiological8:57 ↗
Between 50% and 75% of cloacal malformation patients will develop chronic kidney disease over their lifetime.
epidemiological8:57 ↗
Approximately 17% of cloacal malformation patients eventually progress to end-stage renal disease requiring dialysis or transplant.
epidemiological9:06 ↗
Colostomy creation is typically performed within 24 to 48 hours after birth as the second major surgical priority.
guideline9:22 ↗
The ideal colostomy placement is in the descending colon just past where it is naturally fixed down, which prevents prolapse and preserves distal bowel length for future reconstruction.
clinical9:38 ↗
Transverse colostomy should be avoided because it has higher risk of metabolic acidosis (due to greater fluid and electrolyte absorption) and higher prolapse risk.
clinical10:01 ↗
Low sigmoid colostomy should be avoided because it can interfere with future pelvic reconstruction and may require later relocation.
clinical10:12 ↗
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