A 10-year-old girl from Marathwada with a rare genital disorder known as common cloaca (where a child’s vagina, urinary tract and anus are not separated at birth) was operated on successfully by doctors in Mumbai. The surgeons at SRCC-Narayana Health in Mahalaxmi performed the groundbreaking reconstructive surgeries in which the missing body part (anus) was reconstructed. The child didn’t have a bladder either so Dr Rasik Shah’s team used innovative techniques to create a continent Indiana pouch, granting her a new lease on life.

The Mashery family, who are from a remote area in Marathwada, were worried about their child’s uncommon health condition. They went to multiple hospitals but the surgery kept getting postponed owing to the complexity of the ailment and surgery. Finally, they were referred to SRCC-Narayana Health for further treatment. The child had urine leakage problems and other complications. The surgery was so complex that it had to be done in four parts.

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Speaking to mid-day, Dr Rasiklal Shah, senior consultant, paediatric surgery, NHSRCC Hospital, said “Common cloaca is not that common and the absence of a bladder is very rare. I was seeing it for the first time in my 35 years of paediatric surgical experience. Less than 15 cases have been reported in medical and clinical literature. She underwent laparoscopic pull-through surgery for the imperforate anus surgery about six months back. This surgery separated her rectum from the common cavity.” In addition, the child had a very rare problem of an abnormal connection between the two iliac arteries (blood vessels that provide blood to the legs, pelvis, reproductive organs, and other organs in the pelvic area). The surgeons had to be very careful so that the arteries are not damaged. 

Dr Shah further explained, “Once the anus was well formed, the second operation was performed for the reconstruction of the urinary bladder because she didn’t have one. The patient was facing problems of incontinence of urine, which was continuously dribbling. To overcome the problem, the Continent Indiana pouch was created. This has helped the child remain dry. The Indiana Pouch was effective as it disconnected urethers from the common cloaca, and they were re-implanted in the pouch. She also had a catheterized stoma, from which the parents and the child can put the catheter into this Indiana pouch and empty it periodically. This effectively has stopped the continuous dribbling of urine. The child herself inserts the catheter through the stoma into the pouch to empty it.

“Finally, her colostomy was closed and she started passing stool from the newly constructed rectum. The unique cases had multiple surgeries and the family is completely satisfied with the outcome,” added Dr Shah. The child’s parents said, “We were made aware of the expertise and experience of SRCC-NH in such complicated and rare cases. Doctors here not only performed complicated surgeries but also took good care of us. All the time, they convinced us that problems are plenty but they would overcome each one. We are very grateful to the hospital, doctors, and other staff of SRCC.”

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