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A previously unreported variant of exstrophy cloaca
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Arbay O. Çiftçi, Tutku Soyer, F. Cahit Tanyel
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Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Çiftçi AO, Soyer T, Tanyel FC. A previously unreported variant
of exstrophy cloaca. Turk J Pediatr 2008; 50: 609-611.
Cloacal exstrophy, a rare and complex congenital anomaly, presents with
omphalocele; exstrophied bilateral hemibladders with ureteric or müllerian
remnant orifices; central exstrophied ileocecal bowel plate with superior
orifice of the terminal ileum, inferiorly, the colon, and centrally, the appendix;
bifid rudimentary external genitalia; separated pubic rami; low-set umbilicus;
and epispadias in the classic form. A newborn case of cloacal exstrophy
presenting without an exstrophied intestine and vesicointestinal fistula is
reported. The clinicopathologic features of this previously unreported variant
of cloacal exstrophy are discussed with special emphasis on embryologic
basis. Exstrophied bowel is the main component of exstrophy cloaca, which
makes our case unique with regard to the absence of exstrophied bowel
and vesicointestinal fistula. This well-known fact is not applicable to the
present case. We think that some other unknown mechanisms must be at
work for the development of the cloacal exstrophic anomaly presenting with
a shortened intact colon ending with an anteriorly located anus. Normal
development of the hindgut primarily depends on the normal formation of
the cloacal membrane. The basic morphogenetic processes that consist of cell
deposition, fusion, and merging should achieve the precise balance between cell
proliferation and apoptotic cell death both in hindgut and cloacal membrane
development. Unsatisfactory explanations of many similar malformations are
primarily due to the lack of accurate and illustrative findings in different
fields of embryology. The present case confirms that further studies are
required to clarify the various theories in order to achieve more satisfactory
explanations for these types of rare anomalies.
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