This case is very similar to one of our previous cases here
-oddly there was an atypical cystic pelvic image on first trimester US, which was non specific. Some may believe it does represent a communication between the bladder and the bowel (Prof. R. Chaoui).
-maternal overweight really limited US examination, thus the anal muscle hypoechoic ring could not be assessed.
-there was no fetal ascites.
-the uterine septum was partial.
The combination of an hydrometrocolpos, an anorectal malformation and bilateral ureter & kidney pelvis dilation was very suggestive of a persistent cloaca.
The diagnosis was confirmed at birth: distended abdomen and pelvis with an imperforate anus were seen. Upon surgery, the large bowel was connected to the uterus through a cloacal channel. Anatomic repair is hardly doable in the neonatal period. Therefore, colostomy was performed, and drains were put in both bladder and uterus.For more information about cloaca, refer to the references below.
1.Gupta A, Bischoff A, Peña A, Runck LA, Guasch G. The great divide: septation and malformation of the cloaca, and its implications for surgeons. (2014) Pediatric surgery international. 30 (11): 1089-95. doi:10.1007/s00383-014-3593-8 - PubmedBischoff A, Calvo-Garcia MA, Baregamian N, Levitt MA, Lim FY, Hall J, Peña A. Prenatal counseling for cloaca and cloacal exstrophy-challenges faced by pediatric surgeons. (2012) Pediatric surgery international. 28 (8): 781-8. doi:10.1007/s00383-012-3133-3 - Pubmed
2.Alfred Z. Abuhamad, Rabih Chaoui. First Trimester Ultrasound Diagnosis of Fetal Abnormalities. (2017) ISBN: 9781451193725Fayard C, Blondiaux E, Grigorescu R, Garel C. AIRP best cases in radiologic-pathologic correlation: prenatal and postmortem imaging of a complex cloacal malformation. (2014) Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (7): 2056-63. doi:10.1148/rg.347140018 - Pubmed
3.Thefetus.net numerous articles and case showing multiples situations, slightly different on from another, leading to persistent cloaca diagnosis: