Case Report Cloacal Exstrophy Repair with Primary Closure of Bladder Exstrophy: A Case Report and Review of Literature George Bethell, 1 Navroop Johal, 2 and Peter Cuckow 2 1 Institute of Child Health, University of Liverpool, Liverpool L69 3BX, UK 2 Great Ormond Street Children’s NHS Trust, Great Ormond Street, London WC1N 3JH, UK Correspondence should be addressed to George Bethell; gbethell@doctors.org.uk Received 15 March 2016; Accepted 8 May 2016 Academic Editor: Carmelo Romeo Copyright © 2016 George Bethell et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cloacal exstrophy is the most complex congenital, ventral, abdominal wall defect. Traditionally surgery consists of a staged approach to repair which takes place on many separate theatre visits. In this case a primary approach was undertaken resulting in a relatively short inpatient stay and a reduced risk from multiple surgical procedures under general anaesthesia. 1. Introduction Cloacal exstrophy (CE) is the most complex congenital, ventral, abdominal wall defect with an incidence of less than 1 in 200,000 live births [1]. Conventionally surgical repair consisted of a multiple staged approach; however here we describe a primary approach in a male neonate undertaken by two surgical specialties. 2. Case Report A male neonate was born at 39 weeks’ gestation by normal vaginal delivery to nonconsanguineous parents. He was diag- nosed with CE. Antenatally, bladder exstrophy was suspected at week 21 due to nonvisualisation of the bladder on foetal ultrasonography and the decision was made to continue the pregnancy. Te remainder of the gestation and labour were unremarkable and he has a healthy brother aged 3 years old. Immediate management consisted of dressing the defect to minimalize fuid losses and the risk of infection. He was then transferred, on day 1 of life, from a district general hos- pital to a tertiary pediatric unit, where intravenous antibiotics were given. Neurological examination and spinal ultrasound scan did not fnd evidence of myelocystocele. On full exam- ination we found an imperforate anus, bifd scrotum, and pubic symphysis diastasis. Te small omphalocele was tied as shown in Figure 1. On day 9 of life the patient was taken to theatre where primary closure of cloacal exstrophy with bilateral oblique pelvic innominate osteotomies was undertaken. Firstly the orthopaedic team performed pelvic osteotomies, followed by the pediatric urology team closing the exstrophied caecum with anastomosis to the hind gut, creating an end colostomy, and closing the omphalocele with excision of the appendices. Te bladder plates were then mobilised and sutured together dorsally and ventrally. Te abdominal wall was then closed ventrally with a catheter placed in the neck of the bladder and a drain placed in each hemibladder wall. Finally orthopaedics applied a spica cast. Overall theatre time was fve and a half hours. Te patient was started on total parenteral nutrition on his return to the urology high dependency unit; urine output was monitored closely along with the other vital signs. Te catheters were removed; he was discharged home three weeks following surgery and then seen in clinic when he was eight weeks old (Figure 2). He developed no known complications. Future surgical treatment will involve a bladder neck recon- struction with epispadias repair and a pull through procedure if the external anal sphincter is found to be functioning with electrical stimulation. Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2016, Article ID 8538935, 3 pages http://dx.doi.org/10.1155/2016/8538935