Surgical treatment of traumatic cloaca

Abstract

PURPOSE: This study was designed to evaluate the repair of traumatic cloaca and determine the satisfactory outcome as determined by improvement in the continence mechanism of patients. METHODS: Forty-four patients were entered in this study during a 14-year period. The majority of traumatic cloaca occurred secondary to obstetric injury, most frequently during the first childbirth. No definite medical illnesses precipitated the occurrence of traumatic cloaca. Only two patients had diabetes mellitus, and one patient had prior radiation. All patients underwent surgical repair using puborectalis interposition and sphincteroplasty and perineal body repair, approximating the internal and external sphincter fused bundles and transversus perinei muscles in a vest-over-pants manner. Average stay in the hospital was less than three days, and postoperative morbidity was minimal. One patient had minor postoperative bleeding, which was corrected with cauterization. One patient had a superficial subcutaneous infection, which was drained on the 15th postoperative day. RESULTS: Majority of patients regained excellent control of continence to both flatus and feces. Four patients had unsatisfactory control to passage of flatus. One patient had unsatisfactory control to passage of liquid stool in addition to flatus. All five patients improved, with very satisfactory results, following an exercise program and biofeedback therapy. Six of 12 patients who had perineal discomfort before the surgical procedure, with associated dyspareunia, were the most dissatisfied subgroup in the series. Exact mechanism for perineal discomfort is unclear at this point.