3D Model Helps Elucidate Pediatric Cloacal Malformation

A new study describes how three dimensional (3D) models of congenital cloacal malformation can facilitate endoscopic cystoscopy and complex surgical correction.

Developed at the Medical University of Vienna (MedUni; Austria), the cloacal malformation (also known as anal atresia) 3D model was reconstructed from computerized tomography (CT) data of a real malformation. The model can be used to practice the difficult operation realistically in a non-invasive way, facilitating care of the most complex cloacal malformations, and improving patient outcomes. Training sessions on the 3D model can allow a more precise “real world” operation, helping prevent the newborn patients from suffering permanent incontinence or infertility.


At the conclusion of the 3D reconstruction process, the surgical team should be able to clarify the length of the common channel, the length of the urethra, the anatomy of the vagina or vaginas, the anatomy of the upper genital tract, locations of the rectal fistula and the true rectum, and its position in the pelvis, notably the pubo-coccygeal line. The information allows the surgical team to decide on an appropriate surgical strategy. The study was presented at the 12th European Pediatric Colorectal and Pelvic Reconstruction congress, held during December 2019 in Vienna (Austria).

“This model allows pediatric surgeons and urologists to practice using cystoscopy and identifying the internal structures,” said study presenter Carlos Reck, MD, of the department of surgery. “In future, models could be used not only to train surgeons in this rare condition, but also to practice the operation for a specific patient prior to the initial procedure. This will have a very positive impact upon the outcome for patients.”

A cloacal malformation is most often identified by the midwife directly after birth or by the pediatrician during the initial examination, usually involving an external or internal fistula in the anus that has to be surgically reconstructed in the center of the sphincter muscle. Different forms of anal atresia can involve additional malformations; for example, a fistula can occur between the rectum and urethra in boys and between the rectum and vagina in girls. Depending on the malformation, surgical correction could also include an artificial outlet created for the colon.

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