Mnemonic

Cloacal Division and Imperforate Anus

A memory aid for the division of the cloaca and the origin of anorectal malformations.

Expansion

The urorectal septum divides the cloaca into urogenital sinus in front and anorectal canal behind

Expansion

The hindgut ends in the cloaca, a common chamber shared with the allantois. The urorectal septum grows down to divide it by about week 7:

  • Anteriorly - the urogenital sinus, becoming bladder and urethra
  • Posteriorly - the anorectal canal

The septum meets the cloacal membrane at the future perineal body, dividing it into urogenital and anal membranes, which then break down.

Failures produce:

  • Imperforate anus - the anal membrane fails to break down
  • Rectovesical, rectourethral or rectovaginal fistula - incomplete septation
  • Persistent cloaca - no septation at all, with a single perineal opening

Because the pectinate line marks the junction of endoderm and ectoderm, a “high” lesion above the levator ani has a different prognosis for continence than a “low” one. Look for associated VACTERL anomalies.