The great divide: septation and malformation of the cloaca, and its implications for surgeons

Anita Gupta, Andrea Bischoff, Alberto Peña, Laura A. Runck, Géraldine Guasch*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations

Abstract

The anorectal and urogenital systems arise from a common embryonic structure termed cloaca. Subsequent development leads to the division/septation of the cloaca into the urethra, urinary bladder, vagina, anal canal, and rectum. Defective cloacal development and the resulting anorectal and urogenital malformations are some of the most severe congenital anomalies encountered in children. In the most severe form in females, the rectum, vagina, and urethra fail to develop separately and drain via a single common channel known as a cloaca into the perineum. In this review, we summarize our current knowledge of embryonic cloaca development and malformation, and compare them to what has already been described in the literature. We describe the use of mouse models of cloaca malformation to understand which signaling pathways and cellular mechanisms are involved in the process of normal cloaca development. We also discuss the embryological correlation of the epithelial and stromal histology found in step sections of the common channel in 14 human cloaca malformations. Finally, we highlight the significance of these findings, compare them to prior studies, and discuss their implications for the pediatric surgeons. Understanding and identifying the molecular basis for cloaca malformation could provide foundation for tissue engineering efforts that in the future would reflect better surgical reconstruction and improved quality of life for patients.

Original languageEnglish (US)
Pages (from-to)1089-1095
Number of pages7
JournalPediatric Surgery International
Volume30
Issue number11
DOIs
StatePublished - Nov 2014
Externally publishedYes

Keywords

  • Anorectal malformation
  • Cloaca
  • Common channel

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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