A Jordanian baby girl, born prematurely at 36 weeks gestation, was found to have myelomeningocele associated with duplication of the rectum, urinary bladder, ureters and vagina. This is most likely to have resulted from duplication of the cloaca during early development. The case demonstrates that duplication of the cloaca, albeit rare, may occur in combination with major malformations of the neural tube. Also, the question is raised as to whether or not this is a modification of the VACTERL syndrome since the child also had a cardiac defect.