Cloacal Exstrophy


Surgery, which is often performed as several separate procedures, is the only way cloacal exstrophy can be treated.

A child born with their bladder and part of their intestines opening up to the outside of the body has a deformity known as a cloacal exstrophy. Essentially, the pelvis is split open and pelvic and/or abdominal organs are exposed.

Boys with a cloacal exstrophy may also be born with a flat, short, or split penis. Girls may have two vaginal openings and other genital deformities. Other structures like the abdominal wall,  anus and colon will be affected. It’s also an abnormality that often occurs along with other birth defects, such as spina bifida. Some children with an abnormal bladder also have kidney-related problems.

Making a Diagnosis

  • A cloacal exstrophy may be detected before birth during a routine ultrasound performed to determine how a baby is developing.
  • Otherwise, the condition is obvious at birth.
  • When a child is born with this condition, the bladder and part of the intestine are usually visible around the umbilical cord.
  • A newborn may also have other abdominal structures that are externally visible, such as the liver and spleen.

Cloacal Exstrophy Treatment

  • Because surgical reconstruction to correct cloacal exstrophy is complex, it’s typically performed in stages and spread out over time.
  • The most crucial procedures, such as returning the bladder and bowel organs to their normal positions, are usually performed shortly after birth, if possible.

In most cases, it may be necessary to perform a colostomy to create an artificial opening in part of the intestine for stool to pass into a collection bag. Another option is to connect the colon to the rectum if a child has enough large bowel to produce stool. Other procedures can include:

  • Pelvic osteotomy to adjust hip bones
  • Correction of related spinal abnormalities
  • Genital reconstruction

After Surgical Treatment for Cloacal Exstrophy

Ultimately, the goal of surgery performed to correct this abnormality is to improve a child’s daily quality of life. Because complete surgical correction may take several years to perform, a pediatric urologist often takes time to answer parents’ questions and provide detailed instructions on how to care for a child going through the various stages of surgical reconstruction. Ongoing medical care is often needed if a child has related neurologic, gastroenterologic, renal or nutrition issues.