Treatment is aimed at preventing complications associated with the anomaly, including urinary tract infection and lower GI obstruction and subsequently restoring the anatomy to as near to normal a functional and cosmetic state as possible. In the majority of cases the initial surgery involves forming a colostomy in the descending or sigmoid colon to allow intestinal drainage and avoid dilatation of the lower bowel.41 Following assessment, planning of surgery and growth of the infant reconstructive surgery is undertaken most commonly by the posterior sagittal approach.42 Some anomalies also require a laparotomy to divide a high rectovesical fistula. Surgery of these cases and particularly of the cloaca is complex and should be performed by an experienced surgeon.
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