Persistent cloaca and caudal duplication in a monovular twin, a rare case report

Naomi Cohen, Mohamed Nagy Ahmed, Rachelle Goldfischer, Nahla Zaghloul

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: A cloaca occurs when genitourinary tract and bowel converge into a common channel. We report a case of partial caudal duplication, persistent cloaca and vestigial appendage in a monovular female twin infant. Presentation of case: This is a monochorinonic-diamniotic twin born at 36 weeks with apgars of 9/9. She had a duplicated labia with two clitorises, and a partially formed accessory foot with 2 toes protruding from the right gluteal region. There was anal atresia and a punctate urethral opening in the right genitalia through which she voided spontaneously. X-ray of the accessory foot had rudimentary metatarsals and phalanges. There was left hydroureteronephrosis and a hydrocolpos causing severe mass effect. On the first day of life, she had exploratory laparotomy with a diverting colostomy and mucus fistula and drainage of hydrocolpos. At 6 months of age, she had removal of the accessory foot with flap closure of the perineal defect and vesicostomy. At 15 months of age she had laparotomy for repair of cloaca, excision of presacral pelvic mass and the duplicated vulva. Discussion: Theories of etiology include failure of regression of Kovalevsky's canal (a communication that connects the amniotic and yolk sac), an incomplete form of twinning through iatrogenic damage to the zona pellucida or a failed triplet formation from a single embryo. Conclusion: Caudal duplication with persistent cloaca and vestigial appendage is a rare and complex malformation. Having a unified surgical and medical team to preserve quality of life and to treat complications is of key importance.

Original languageEnglish (US)
Pages (from-to)137-140
Number of pages4
JournalInternational Journal of Surgery Case Reports
StatePublished - 2019
Externally publishedYes


  • Anal atresia
  • Caudal duplication
  • Cloaca
  • Duplicated genitalia
  • Hydrocolpos
  • Vestigial appendage

ASJC Scopus subject areas

  • Surgery


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