This case is very similar to one of our previous cases, except:

• oddly there was an atypical cystic pelvic image on first trimester US, which was non-specific. Some may believe it does represent communication between the bladder and the bowel (Prof. R. Chaoui).
• maternal weight really limited US examination, thus the anal muscle hypoechoic ring could not be assessed. 
• there was no fetal ascites
• the uterine septum was partial

The combination of a hydrometrocolpos, an anorectal malformation and bilateral ureter and kidney pelvis dilation in a female fetus was very suggestive of a persistent cloaca.

The diagnosis was confirmed at birth: distended abdomen and pelvis with an imperforate anus were seen. Upon surgery, the large bowel was connected to the uterus by an atretic cloacal channel.  Anatomic repair is hardly doable in the neonatal period. Therefore, colostomy was performed, and drains were put in both bladder and uterus.

For more information about cloaca, refer to the references below.

Dr Fabrice Cuillier contributed to the US images, and of course, the neonatal pediatric team and the pediatric surgical team also contributed to this case.