EP07.32: From diagnosis to treatment: cloacal abnormality diagnosis and management in monoamniotic twins

A 23 year old was referred in her third pregnancy with phenotypically female monoamniotic twins at 27 weeks. One twin had been diagnosed with transposition of the great arteries (TGA) and the other (twin 2) had an abdominal cyst diagnosed at 17 weeks. Twin 2, by 27 weeks had developed severe ascites and dilated bowel loops with unilateral hydronephrosis and a prominent clitoris. There were twin tubular structures noted posterior and adjacent to the bladder. The findings were thought to be secondary to bowel perforation or a cloacal abnormality. By 29 weeks polyhydramnios developed and was managed with indomethacin followed by an amniodrainage of 2900mls at 30 weeks (Microarray normal). Multidisciplinary discussions regarding timing of delivery resulted in an elective Caesarean section at 32 weeks. Twin 2, was noted postnatally to have gross abdominal distension and a single perineal opening consistent with cloacal anomaly. Ultrasound demonstrated probable bladder perforation with heavily septated ascites, mullerian duplications, dilated bowel loops and bilateral hydronephroureters. Emergency exploratory laparotomy demonstrated grossly dilated hollow organs and multiple bowel adhesions. A vaginostomy tube and a suprapubic catheter were inserted and a loop colostomy performed. Cystovaginoscopy at 8 months of age confirmed the complex cloacal anomaly with long common channel of 4cm. Her reconstruction is likely to be staged with the anorectalplasty in early infancy and a subsequent reconstruction of her genitourinary tract when she is older. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.