Pediatric and Developmental Pathology

, Volume 8, Issue 3, pp 339–354 | Cite as

Association of Cloacal Anomalies, Caudal Duplication, and Twinning

  • Joseph R. Siebert
  • Joe C. Rutledge
  • Raj P. Kapur


Cloacal anomalies exhibit a wide variety of morphologic types and accompanying clinical severity. The association of malformations of the cloaca with partial, complete, or conjoined twinning has been appreciated for some time, but, with the advent of prenatal ultrasound technology, appears to occur with a greater frequency than once thought. This observation has important implications for pathogenesis. We present 2 representative cases, a 19-week-old female fetus with duplication of several caudal structures and a 21-week-old male fetus with cloacal exstrophy variant and demised co-twin with lower abdominal wall defect, extruded intestinal tract, absent external genitalia, and imperforate anus. These findings and previously published theories suggest that certain models of monozygotic twinning may apply to the pathogenesis of cloacal anomalies. Specifically, the partial or complete duplication of the organizing center within a single embryonic disc may increase the risk of mesodermal insufficiency and thus account for the failure of complete development of the cloacal membrane and consequent exstrophy or other aberration.


cloaca conjoined twin exstrophy parasitic twin partial twin twin 



We are grateful for the expert consultation afforded us in case 2 by Michael E. Mitchell, MD.


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Copyright information

© Society for Pediatric Pathology 2005

Authors and Affiliations

  • Joseph R. Siebert
    • 1
    • 2
  • Joe C. Rutledge
    • 1
    • 3
  • Raj P. Kapur
    • 1
    • 2
  1. 1.Department of Laboratories (A-6901)Children’s Hospital and Regional Medical CenterSeattleUSA
  2. 2.Department of PathologyUniversity of WashingtonSeattleUSA
  3. 3.Department of Laboratory MedicineUniversity of WashingtonSeattleUSA

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