Cloacal Exstrophy

Update: Pictures of this surgery have been removed. Combine the fact that the condition is so incredibly rare plus the city I had been living in, and it would be possible to identify the infant who received the operation, if someone was looking.

Today at the hospital we had a very rare surgery, so much so that the surgeons were operating almost by consensus.  It is a male infant, about one week old, which was found in a Somali refugee camp. There were three fully trained pediatric surgeons operating and more in the room observing and commenting (including Safwat from the Coptic Hospital, who came from Nairobi to see).

This baby was thought to have an embryological defect called cloacal exstrophy.  What you are looking at in the first picture is the baby's urinary bladder, which is open like a plate because it never closed correctly, along with the end of the intestine, which is open as well and attached to the bladder plate.  The phallus looks as if cut in two, with half on either side of the defect.

Actually this baby ended up being relatively lucky because we thought, as is usually the case, the third embryonic segment of intestine would more or less not be present, but it was.  So actually I believe this was a rectal exstrophy. 

In this surgery, the docs separated the intestine from the bladder, excised the part that wasn't a tube, and pulled the rest through to sort of where the anus should have been.  They left the bladder open as is for now, as can be seen in the last picture.  That was the end of the surgery today.  The next operation will be in six months or so.