Rare – Complete transection of sphincter during labor (4th Degree), complete faecal incontinence
History
A 29-year-old female patient in whom a total transection of the sphincter and anus was performed during childbirth and despite the attempt of suturing by her gynecologist, shows complete fecal incontinence. This is the most severe form of sphincter injury of the 4th Degree as it also includes a transection of the anus-rectum, which is extremely difficult to restore.
As you can see in the photo the vagina and anus are joined and the feces are discharged uncontrollably.
Surgical Treatment
The figure shows the normal anatomy, where the perineal body is interposed between the vagina and the anus.
The four types of injuries:
- 1st Degree: Injury to the skin of the perineum and/or vagina
- 2nd Degree: Perineal muscle injury without the sphincter
- 3rd Degree: Injury to perineum and sphincter muscles
- 4th Degree: Injury to the perineum, sphincter and rectal muscles
Sphincter and perineal reconstruction included suturing the vagina, sphincter muscle, transversus perineus muscle, levator muscle, recto-anal wall and perineal skin.
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OLYMPUS DIGITAL CAMERA
The final image of the restoration is shown in the next photo and is compared to the before image and the shape to the normal anatomy.
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The patient 4 years later and after two more deliveries, one of which was a twin pregnancy, in which she gave birth by caesarean section, does not have any incontinence problems.
Clinic of Intestinal and Anal Diseases
Operations of this type are highly specialized and are performed in very few centers internationally. The Intestinal and Anal Diseases Clinic comes to meet this very need for specialized surgical techniques for the intestine and anus in Greece.