Ulcerative colitis of the neovagina as a postsurgical complication of persistent cloaca

The great divide: septation and malformation of the cloaca, and its implications for surgeons

“…Moreover, 25% of cloaca patients also require a type of vaginal replacement, most commonly with bowel. Disadvantages of having a bowel neovagina includes the possibility of future complications such as ulcerative colitis in the neovagina 30 and malignant potential 31;32 where the neovagina epithelium created with rectum or colonic type of tissue creates a transition zone in which the graft is suddenly subjected to new contacts or stresses 33 . We and others have shown that these transition zones are susceptible to tumor formation in human and mice 34;35 .…”

“…Currently, all the available options for vaginal replacement such as: skin, buccal mucosal, small bowel, colon, and rectum offer some risks, disadvantages, and complications 30-32; 63-67 ; since none of those work as well as native vaginal tissue. Future complications include malignant potential 31-32 , no growth of a neovagina constructed during infancy due to lack of hormonal response of the neovaginal tissue during puberty, neovaginal prolapse 63-64 , diversion colitis 63-65 , ulcerative colitis in the neovagina 30 , and excessive mucous production 64 .The fact that the vagina is an organ that does not require much functionality (contraction, continence, and peristalsis) makes it an ideal cavity for tissue engineering.…”

“…Future complications include malignant potential 31-32 , no growth of a neovagina constructed during infancy due to lack of hormonal response of the neovaginal tissue during puberty, neovaginal prolapse 63-64 , diversion colitis 63-65 , ulcerative colitis in the neovagina 30 , and excessive mucous production 64 .The fact that the vagina is an organ that does not require much functionality (contraction, continence, and peristalsis) makes it an ideal cavity for tissue engineering. A recent report described a tissue engineered autologous vagina that was successfully used in 4 patients offering a good promise for patients with cloacal anomaly that require vaginal replacement 68 .…”

Ulcerative colitis in a neovagina

“…Diseases of the colonic mucosa continue to happen in the neovagina following reconstruction, adenocarcinoma of the colonic mucosa has been reported in the neovagina [7,8] , several case reports have reported ulcerative colitis in both the colon and the neovagina after neovagina creation for persistent cloaca, gender reassignment, reconstruction following surgical excision of vagina and androgen insensitivity syndrome [9][10][11][12] .…”

Intestinal Vaginoplasty Revisited: A Review of Surgical Techniques, Complications, and Sexual Function

“…The exact etiology of diversion neovaginitis is unknown, but it is ascribed to diversion of the fecal stream, leading to inefficient butyrate generation by neovaginal microflora and subsequent malnutrition of the butyrate-dependent colonocytes [41,54,55]. In literature, only a handful of cases of diversion neovaginitis (colitis) or ulcerative colitis have been reported [46,50,[52][53][54][55][56][57][58][59][60]. There are no studies that focus specially on diversion neovaginitis.…”