Iatrogenic cloaca: A case report

Table 2 Published case series/reports on iatrogenic cloaca: Aetiology, presentation, management, and outcome

Ref.	Age, gender/No. of patients	Aetiology	Clinical presentation	Examination	Evaluation	Operative procedure	Follow up
Ibrahim et al[14]	45, F	Remote vaginal delivery	Postcoital bleed, faecal urgency, NO faecal incontinence	Grade 4 perineal tear, Absent perineal body, receding post vaginal wall, no anterior anal sphincter	Manometry- diminished IAS and EAS pressure, hypersensitivity of rectal sensation, RAIR+	Sphincteroplasty (overlapping), levatoroplasty, vaginoplasty, perineal body reconstruction, rectocele repair	6 months- no faecal incontinence
Balmaceda et al[1]	17, F	Vaginal delivery-7 days (high BW, forcep usage)	Anal incontinence, vaginal discharge	Hypotonic sphincter, disruption of anterior rectoanal wall and perineal body, lower middle third of rectovaginal septum, vaginal mucosa	EUS- anterior defect of IAS+EAS	Sphincteroplasty (overlapping), anoplasty, perineal body repair, vaginoplasty	Postop- perianal subcutaneous fistula- healed spontaneously. Six months- good continence
Stavros et al[15]	39, F	3 years after vaginal delivery	Common cloaca	Absent perineal body, absent resting and squeeze pressure.	-	-	-
Venkatesh et al[16]	44	Obstetric injury (39), Others (5)	Faecal incontinence, recurrent infections	Anterior defect of IAS+EAS	Manometry and imaging	Sphincteroplasty, levatorplasty, and flaps	Improved continence in 39, incontinence to flatus in 4, incontinence to liquid and flatus in 1
Haitham et al[17]	30, F	Post primary repair of genital injury due to sexual assault	Stools per vagina	Rectovaginal fistula at 2 cm from anal verge. EAS intact		Fistula repair with diversion colotomy	Asymptomatic after 1 year of stoma reversal
Spelzini et al[18]	27, F	2 year post vaginal delivery	Stool per vagina	Common cloaca		Rectovaginal septum repair, perineal body reconstruction	2 years, asymptomatic
Present case	15, F	Mismanaged calpohematometra	Stool per vagina	Common cloaca	MRI	Anorectoplasty, vaginoplasty, sphincterplasty with levaterplasty and creation of rectovaginal septum	2 months asymptomatic, waiting for colostomy closure

F: Female; IAS: Internal anal sphincter; EAS: External anal sphincter; EUS: Endoscopic ultrasonography; RAIR: Rectoanal inhibitory reflex; MRI: Magnetic resonance imaging.