Paper - Case of cloaca in a child
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Case of Cloaca in a Child
By Mr F. Imlach, Liverpool.
April 24, 1872.
The following case occurred in the winter 1871-2, in Dr Matthews Duncan’s ward, in the Royal Infirmary. The report is taken chiefly from the ward case-book ; and the case is published by his permission.
Margaret M., zt. 6, residing in the Grassmarket, was brought to Ward XVI. Royal Infirmary, 20th December 1871, with a complaint of want of control over the urine and feces, and of having only a single outlet for them.
The mother stated that the child since her birth had passed urine and faeces involuntarily, and always through the same passage.
The mother was 19 when she had this her first-born child.
She went the full time. Since then she has had three others — a boy and two girls—two living, one girl still-born. They were all naturally formed. The mother herself looks strong and healthy. Her husband is alive. She says they are both naturally formed, and that her relatives, so far as she knows, are so also.)
The general development of the child is good, but the local trouble seems to tell on its health. The inner sides of the thighs and legs are extensively excoriated by the continuous soaking of the mingled excreta. Physical examination under chloroform showed a cloacal orifice for bladder and rectum. A large phosphatic calculus projected into the vulva, and appeared to be ulcerating out of the bladder. Previous to further examination of the parts, Dr Matthews Duncan seized the stone with a pair of forceps, and extracted it without much difficulty. It was soft, and crumbled during extraction. The bladder was then washed out. The fragments of the stone which were preserved weighed, when dried, 160 grains ; but so much was lost during the washing of the bladder, &., that it must have weighed, when whole, little under half an ounce.
22d Feb. 1872. — Physical examination under chloroform at her home. There was no trace of an anus in the natural situation, not even a puckering of the skin. There was a distinct vulva with natural mons veneris, labia majora, fourchette, clitoris, nymphe, and vestibule. The labia were slightly apart, and sodden. There was a well-marked perineum stretching from the coccyx to the vulva. On further separating the labia, two large, round, and open orifices were seen, one in front of the other, with only the thin free edge of a septum between them. The posterior orifice communicated with the rectum, and just admitted the forefinger. It appeared to be a merely fibrous constriction of the lower end of the rectum; there was no muscular grip, and not the slightest power of closure of the orifice. The rectum was roomy, and inclined to the left. Immediately in front and somewhat to the right was the other orifice. This, too, would admit the forefinger, which passed at once into the bladder. Its tip could easily be felt above the pubes by the other hand. The bladder measured two inches. It was capacious, soft, cool, and appeared to the touch in every respect natural. Between the , bladder and rectum was a septum, the thin free edge of which (previously alluded to) felt fibrous, was thin but strong, and was situated about half an inch within the vulva. The forefinger was again introduced well into the rectum, and careful search made for vaginal orifice, vagina, or uterus, but none could be felt. A female metallic catheter was then passed into the bladder, and the. direct apposition of bladder and rectum ascertained by pressing the finger against the catheter, the septum being felt between them. The finger and catheter were withdrawn. A similar and equally careful examination of the bladder was made, and with a like result. The catheter was passed into the rectum, and the septum again felt between it and the finger.
Cite this page: Hill, M.A. (2019, September 23) Embryology Paper - Case of cloaca in a child. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_Case_of_cloaca_in_a_child
- © Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G