Reconstruction of anal sphincter muscles in post-traumatic sphincter damage with fecal incontinence – case report

Abstract

Extra-obstetric injuries to the anal area are rare. The cause of isolated damage is most often accidents when working with utility machines or impalement injuries caused by sharp objects, as well as transport accidents. The authors present a rare case of a young man who, 8 years ago, suffered an extensive pelvic fracture injury, with rectal detachment, and extensive injuries to the thigh and buttock area with skin-fat lobe detachment in the course of a transport accident. At the pediatric surgery center, fracture stabilization was performed and colostomy was created, which was closed when patient completed 15 years of age. Due to persistent symptoms of fecal incontinence, the man was qualified for a late reconstruction of sphincters. Prior to the operation, detailed imaging diagnostics were performed. 6 months after the procedure, the patient declared significant improvements in quality of life and fecal retention (3/20 points on the Wexner Faecal Incontinence Quality of Life Scale). After complete healing of the wound, the patient was prescribed sphincter electrostimulation. The authors conclude that there are no clear guidelines for the management of patients with rectal and anal injuries. Treatment should be individualized on a case-by-case basis. In the situation of supplying the acute damage to the sphincter apparatus, it is crucial to verify that the injury does not also include the intraperitoneal organs, as this determines further proceedings and a possibility of primary definitive reconstructive surgery. For the successful functionality of sphincters, it is also important to implement muscle-strengthening exercises, “biofeedback” therapy and electrostimulation.