Exstrophy of the cloaca

　　Exstrophy of the cloaca is caused by the rupture of the large cloacal membrane in front of the separation of the cloaca into the anterior urogenital sinus and the posterior rectal sinus. In males, the bladder and urethra are connected to the rectum, and in females, the bladder and vagina are connected to the urethra and vagina, and the rectum. In the inverted tissue, the middle is intestinal mucosa, on both sides are bladder mucosa, the upper edge is connected like a horseshoe, and each has its own ureter, and the inverted intestinal tract resembles a cecum. Patients excrete urine, feces, and gas from the rectum, urethra, and vagina.

　　This condition is most commonly associated with spina bifida and biventricular veins. Soper analyzed a group of infants with exstrophy of the cloaca, except for concurrent pelvic malformations, about 50% had concurrent myelomeningoceles, umbilical hernias, and biventricular veins.

　　After birth, the patients with exstrophy of the anal pouch are found to have bladder and intestinal prolapse, umbilical hernia. Urine, feces, and gas are excreted from the rectum, urethra, and vagina. In the prolapsed tissue, the middle is intestinal mucosa, and the sides are bladder mucosa. Males may have absent penis, absent scrotum, double penis, and split scrotum. Females may have absent clitoris and clitoral bifidity. In addition, there may be associated with pelvic deformities, skeletal abnormalities, meningocele, double veins, etc.

　　The primary defect of this disease is the early mesodermal developmental disorder and defect of the subumbilical mesenchymal tissue, cloacal septum, and sacral lumbar vertebrae. Therefore, early detection, early diagnosis, and early treatment are of great significance for preventing this disease. Regular checks should be done during pregnancy, and chromosomal screening should be done promptly if the child shows a tendency for developmental abnormalities.

　　Exstrophy of the anal pouch is the rarest and most serious congenital anomaly, also known as bladder enterocyst. The following examination measures are taken for this disease.

　　1. Ultrasound Examination:Check for deformities of solid organs such as liver, kidney, spleen, and pancreas.

　　2. X-ray Examination: Pelvic X-ray, lumbar spine anteroposterior and lateral radiographs to check for pelvic and spinal deformities, intravenous urography can show other deformities of the urinary system and whether there is upper urinary tract obstruction.

　　Patients with this disease should eat light and eat more vegetables and fruits, such as bananas, strawberries, apples, etc. Because they are rich in nutrients, eating more immune-boosting foods such as propolis can enhance personal disease resistance. In addition, a reasonable diet should be maintained, and attention should be paid to adequate nutrition. Avoid smoking, drinking, spicy foods, and greasy and cold foods to prevent recurrent attacks of the disease.

　　The treatment of this disease mainly involves reconstructive surgery, including the repair of umbilical hernia, intestinal tract, urinary tract, and external genitalia. The treatment of the urinary tract involves first separating the two halves of the bladder from the intestinal tract and suturing them into one, preferably closing the bladder at the same time, followed by intermittent catheterization or the establishment of an artificial sphincter. It may be necessary to use colonic augmentation of the bladder or ileal bladder or ureteral skin fistula for urinary diversion. Since the penis does not develop, some authors suggest changing the external genitalia to female.