Giriş ve amaç: Kloaka anomalisi ve konjenital poş kolona bagh kzsa barsak sendromlu olgumuz; ilk ameliyatta stoma yerinin belirlenmesinin, definitif ameliyatz naszl etkileyebilecegini vurgulamak amaczyla tartz§limz§tlr. Olgu sunumu: 33. gebelik haftasmda dogan kzz bebek, postnatal ikinci giinde kloaka anomalisi ve konjenital poş kolon tam/an ile opere edilerek sol aft kadrandan po§ kolon ve r;ok klsa jejunoileum sebebiyle ileostomi ar;lidz. Ameliyat sonrasz ikinci aymdan itibaren bilateral grade II hidronefrozu ve po§ kolona ait radyolojik bulgulan geriledi. 20 ayhkken kloaka anomalisine yonelik operasyon oncesi degerlendirildi. Sistoskopide kloaka ortak kanalmm yakla§zk 6 mm r;apmda, 3 em boyunda oldugu, uretramn 8-10 mm gibi r;ok klsa oldugu ve geni§ bir mesane boynu §eklinde mesaneye ar;zldzgz görüldü. Üretranın başlangıcı ile çift vagina orifzsi ortasında, içine sistoskopun ilerletilemediği rektal fistill oldugu tahmin edilen 2mm 'lik orifis izlendi. Posterosagittal insizyon sonrasz urogenital sinus mobilizasyonu ile uretrovaginorektoplasti yaplidz. Ancak distal barsak uzunlugu sadece 3-4 em oldugu ir;in abdominal yolla stoma serbestle§tirilerek, proksimal stoma (ileostomi) dogrudan rektum §eklinde perineye pull trough yapzlarak neoanus olu§turulabildi. Sonuç: Konjenital poş kolonu olan bu kloaka vakamzzda definitif operasyon esnasmda rektumun posterior sagittal yakla§zmla yeterince eksplore edilememesi abdominal yakla§lml zorunlu hale getirmi§tir. Po§ kolonlu olgularda stoma seviyesi ar;zilrken definitif ameliyat ve klsa barsak sendromu apsmdan barsak uzunlugunun maksimum korunmasına dikkat edilmelidir.

Background and Aim: Pouch colon in persistent cloaca is very rare anomaly. We reported a case with pouch colon in persistent cloca diagnosed to underline the importantance of the stoma leveling on the definitive operation. Case Report: 32 gestational weeks girl baby was operated on the second postnatal day because of Persistent cloaca. Preoperative abdominal X-ray showed dilated distal colon and ultrasonography findings were bilateral hydronephrosis and 8 em diameter cystic mass at the left lower quadrant. There was totally 50 em intestine betweeen distal to trietz ligament and distal ileum was ending directly with dilated pouch in abdominal exploration and Ileostomy was created 5 em proximal to cystic mass. When she was 20 mounths old, cystoscopy was showed 6 mm diameter common channel with 3 em length and very short urethra (8-1 0 mm) with a wide opening to the bladder. There was a meatus between urethral opening and double vagen orifice which was estimated to be the rectum. Urogenital sinus mobilisation was done with rectum and double vagina and urethral plane. Pouch colon totaly excised and proximal stoma pulled thorough to perineum and the abdomen was closed witout any stoma. Neourethra was reconstructed from commen channel, vaginal septum was excised and vaginal orifice was reconstructed by vaginoplasty, perineal body reconstructed, and the edge of the stoma was pulled through the perineum into the anal channel. Conclusions: In the management of the pouch colon, stoma leveling is very important espacially in short bowel syndrome. The abdominal aproach and proximal stoma pull through were done because short distal colon didn ~ give permission for pull trough. Posterosagittal anorectoplasty without stoma would be done if the intestinum is short.