You are called to see a 36-week old newborn with the anatomy pictured below.

 

 

 

[size=20px]Meconium is passing from the prolapsed bowel and urine is noted from the right and left lateral portions of the mucosal mass. Abdominal ultrasound shows two morphologically normal kidneys, two ovaries, two fallopian tubes and two hemiuteri. At the time of operation which of the following is appropriate for this patient with this abdominal wall defect?

 

A appendectomy

 

B ileostomy

 

C use cecal plate for bladder augmentation

 

D use hindgut for vaginal reconstruction

 

E incorporate cecal plate and distal hindgut into fecal stream[/size]

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B

think again my friend

(Untitled)

 

E

E

correct

 

Infants with cloacal exstrophy are subject to metabolic derangements and growth failure. Patients with ileostomies suffered acidosis and failure to thrive and required incorporation of the defunctionalized colon into the fecal stream.

 

Those with colon used for their urologic or genital reconstruction may be left unable to form solid stool. So all available hindgut should be used for the initial colostomy and avoid use of colon for urologic or genital reconstruction. Although these patients would have poor prognosis for bowel control, social continence can be achieved with bowel management.

Edited October 25, 20206 yr by Admin