An 18-year-old female patient who had undergone surgery for cloacal exstrophy (reconstruction of the intestinal and urinary tracts) in another care centre, and who came to our department presenting with absence of the anterior abdominal wall, unstable skin, pubic eventration, numerous scar sequelae and an incontinent urinary reservoir.

Wall reconstruction, eventroplasty and urinary ostoma plasty are scheduled, working as a team with the Surgery and Paediatric Urology Service.
1st surgical stage:
Consisted of the placement of 2 rectangular expanders of 1000cc. (with expansion capacity up to 1500cc) and 15.2 cm. long x 7.3 cm. wide with remote valve (Silimed®) below the abdominal cellulo-fatty tissue and above the aponeurosis of the greater oblique muscle in subcostal and lateral position. Expansion was performed at a rate of between 50 and 100 cc of physiological solution at intervals of 1 week to 20 days, depending on the patient's tolerance, until reaching 1300 cc.

2nd Surgical time:
Once the expansion is complete, the urinary wall and ostoma surgery is scheduled.
The paediatric plastic surgery team removed the expanders and the urological surgeon performed the urinary ostoma plasty. Both surgical teams then proceeded to reconstruct the upper and middle thirds of the wall using the remaining tissues of the rectus abdominis sheath, rectus abdominis muscle and remaining scar tissue. In the lower third and pubis, due to the absence of tissue, it was decided to use a 15 x 10 cm polypropylene (Prolene®) prosthetic mesh over the lax scar tissue covering the eventration, anchoring it to the pubic bones and the greater oblique muscle on both sides. Reconstruction of the skin and cellulo-fatty tissues is achieved by advancing the expanded lateral tissues.

The patient evolved favourably without complications and vaginal reconstructive surgery was performed one year later.

Despite the pubic diastasis of almost 17cm, the patient has no gait disturbance and has not undergone any treatment by her own decision.