Doctor CalistoMD
Home FAQ ES Refer a patient

Congenital — present from birth

Anorectal Malformations & Cloaca

Full pelvic and anorectal reconstruction across the malformation spectrum — including cloaca — with a focus on the long-term function that matters: bowel control, urinary control, and healthy anatomy for the child's whole future.

Request a consultation → Read family FAQ

What is an anorectal malformation?

Anorectal malformations are a spectrum of conditions in which the anus, rectum, and sometimes the urinary and gynecologic structures do not form normally before birth. They range from a low malformation corrected in infancy to a cloaca, where the rectum, vagina, and urethra share a single channel and reconstruction is among the most demanding in all of pediatric surgery.

Repair restores the anatomy — most often through a posterior sagittal reconstruction (PSARP) — but the real goal is long-term function. That requires a surgeon who plans for the child's whole future, not only the first operation. A precise first reconstruction is the single best predictor of a continent child.

How Dr. Calisto approaches it

  • Full pelvic and anorectal reconstruction across the malformation spectrum, including cloaca
  • Complex and redo reconstruction for children with poor results from a prior repair
  • Published technique for rectovestibular fistula with vaginal agenesis, preserving the natural fecal reservoir
  • Lifelong continence planning through a dedicated bowel-management program

Why families come to Dr. Calisto

Cloaca and complex anorectal reconstruction are among the most demanding operations in pediatric surgery, and outcomes depend heavily on experience and planning. Dr. Calisto directs Florida's first comprehensive pediatric colorectal center and routinely cares for children referred after a first operation elsewhere.

  • Experience across the full malformation spectrum, including cloaca
  • Redo and reoperative pelvic reconstruction
  • Coordinated urology and gynecology planning for complex anatomy
  • Lifelong bowel-control follow-up, not just the first repair

Frequently asked questions

What exactly is an anorectal malformation?
It's a group of birth differences in how the anus and rectum connect to the outside. In some children the opening is in the wrong place, too narrow, or absent; in others the rectum connects to the urinary or genital tract through a channel called a fistula. The specific anatomy varies a lot, which is why an experienced colorectal team is important.
What does treatment look like?
It depends on the type. Some newborns need a temporary colostomy first to allow stool to pass while they grow, followed by a reconstruction (often a posterior sagittal anorectoplasty, or PSARP) that places the rectum correctly within the muscle complex. The colostomy is later closed. Simpler malformations may be repaired in a single operation.
Will my child be able to toilet train and have bowel control?
Outcomes depend on the type of malformation and the muscles and nerves present. Many children achieve voluntary bowel control. For those who need help, a bowel management program can keep them reliably clean and in regular underwear, which is life-changing for school and confidence.
My child was repaired elsewhere and isn't doing well — can that be helped?
Yes. A meaningful part of specialized colorectal practice is caring for children who continue to have problems after an earlier repair — ongoing soiling, constipation, or anatomy that needs revision. A careful re-evaluation can identify whether reoperative surgery or a tailored management plan would help.

Talk with Dr. Calisto

Whether this is a new diagnosis or a second opinion after care elsewhere, an early conversation often changes the plan for the better. Pediatricians and families are welcome to reach out directly.

Request a consultation →