A Rare Case of Hydrometrocolpos in a Neonate with Persistent Cloaca

Abstract

A full-term newborn presented with imperforate anus and a grossly distended lower abdomen, with a palpable cystic mass reaching the level of the umbilicus. Perineal inspection revealed a single perineal opening located in the female-like genital area (Figure A). Catheterization of this single orifice successfully drained urine, confirming a persistent cloaca. Preoperative X-ray examination (Invertogram) revealed high anorectal malformation (ARM) (Figure B). (Prone cross-table lateral view Xray examination is currently practised instead of invertogram). Preoperative abdominal ultrasound suggested a massive fluid collection behind the bladder. At laparotomy, a tense, bilobed pelvic mass was identified, representing a massive hydrometrocolpos (distension of the vagina and uterus with secretions).  The two  “horns” seen on the upper part of the mass represent double uterus(uterus didelphys) or bicornuate uterus which is frequently associated with complex cloacal malformations. This distension was secondary to the high-pressure common channel shared by the urinary, genital, and gastrointestinal tracts.