A 1-day-old female is born at 37 weeks gestation by spontaneous vaginal delivery. Her mother received no prenatal imaging. Examination reveals a single perineal orifice and absent anus. Her abdomen is distended. She is diagnosed with a cloacal anomaly. Abdominal ultrasound reveals hydrocolpos and bilateral hydroureteronephrosis. She develops progressive respiratory distress and increasing respiratory support is required. Because of her respiratory distress a percutaneous vaginostomy tube is placed at the bedside to decompress her hydrocolpos. As clear urine drains from the hydrocolpos her respiratory distress improves. Her abdominal distention improves mildly but is still present. She is taken to the operating room for diverting colostomy and vaginostomy. Her vaginostomy drains urine during the postoperative period but her abdominal distention persists. A follow-up ultrasound reveals persistent hydrocolpos and bilateral hydroureteronephrosis.