• Suraj Singh, Anuj Kayastha, Anupama Thapa, Bijay Thapa, and Sulochana Dahal.
• Department of Pediatrics Surgery, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal.
• JNMA J Nepal Med Assoc. 2023 Apr 1; 61 (260): 375378375-378.

Unlabelled Omphalocele, exstrophy of cloaca, imperforate anus, and spinal defects complex is a rare malformation complex that includes omphalocele, cloacal exstrophy, imperforate anus and spinal defects with the incidence of 1 in 200,000 to 400,000 pregnancies and is even rarer in twin gestation. The etiology of this complex is still unclear. Most cases are sporadic. Prenatal screening must be done for diagnosis and appropriate multidisciplinary management of cases. In severe cases, termination of pregnancy is considered. We present a 4-day first twin child with underdeveloped ambiguous genitalia delivered via emergency lower section cesarean section at 32+3 weeks of gestation with giant liver containing omphalocele, cloacal exstrophy, imperforate anus and meningocele with severe pulmonary artery hypertension and non-visualization of right kidney and ureter, absence of uterus, fallopian tubes and right ovary. Separation and repair of the cecum and bladder were done. The ladd procedure was performed. Ileostomy was created and single-stage repair of the abdominal wall was done.Keywordsanorectal malformations; bladder exstrophy; case reports; neural tube defects; umbilicus.

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