Prenatal diagnosis of persistent cloaca has been reported, but is not always accurate [12,13]. In contrast, clinical diagnosis is simple. In girls, a single opening on the perineum is always suspicious of a cloacal malformation. The length of the introitus is characteristically shorter than in a normal girl. Cloacas have only rarely been reported in boys in whom the urethra and rectum has coalesced into a common channel that is connected to the external surface in the perineal or anal area . In girls, an abdominal mass and severe abdominal distension resulting from hydrome-trocolpos and/or rectal obstruction can frequently be observed. Additional malformations of the lower limbs, genitalia, skin (hemangioma), urogenital tract, vertebral, cardiac, and gastrointestinal deformities, among others may occur. A rarity is the posterior clo aca, described first by Peña and Kessler . In these patients the vagina and urethra fuse together but the urogenital sinus (UGS) opens into the anterior rectal wall; the rectum is normal or minimally mislocated anteriorly. The most severe type of deformity is cloacal exstrophy, a combination of cloaca with bladder exstrophy that was first reported by Rickham in 1960 . It is now called vesicointestinal fissure (see Chap. 14 for details).
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.