Cloacal anomaly with bladder tumor
A 36-year-old married female having two children, both delivered by caesarian section, presented to us with complaints of urinary frequency, urgency, and urge incontinence associated with low-grade fever. She had history of recurrent urinary tract infections (UTI) since childhood and had received multiple courses of antibiotics. She had been diagnosed as having a persistent cloaca and had undergone multiple cutback procedures at birth. On pelvic examination, a single short common channel opening in the perineum was found. All preoperative blood investigations including renal function were normal.\nUltrasound abdomen showed a mass lesion in urinary bladder []. Computed tomography (CT) abdomen and pelvis with three dimensional reconstruction confirmed the presence of persistent cloaca, a large mass in the bladder with infiltration into the pubic bones [] with uterus didelphys and rectum crossing between the two uteri and opening into the bladder base []. Cystoscopy revealed a large solid, sessile growth arising from dome and anterior wall of urinary bladder, rectum opening just distal to bladder neck and two cervical openings posteriorly. Cold cup biopsy from growth revealed a moderately differentiated squamous cell carcinoma (SCC).\nWith a diagnosis of squamous tumor with persistent cloaca, radical cystectomy and urinary diversion were planned. Intraoperatively, we found a 15 cm pouch colon along with a large tumor involving anterior wall of bladder, infiltrating the pubic bones. Two uteri were lying on either side of the bladder []. Pelvic exenteration, standard bilateral pelvic lymph node dissection, pubectomy, and wet colostomy were performed. Operative time was 6 hours with 1200 cc blood loss and the patient received 2 units of packed cell transfusion. Postoperative course was uneventful except for a small incision disruption which was managed with secondary suturing. Histopathologic findings confirmed the presence of squamous cell carcinoma. Resected margins were free of tumor and 50% of pelvic nodes showed tumor metastases. She was started on adjuvant methotrexate and platin-based combination chemotherapy but finally lost to follow up.