Muhammad Azhar Qureshi.
Anal sphincter transaction - repair by overlap sphincteroplasty
Pak Armed Forces Med J Dec 2007;57(4):327-9.
PAF Hospital, Karachi

A young male was admitted with a day old history of fall over a sharp metallic object leading to transanal impalement injury and complete transection of internal and external anal sphincters at 50 clock position when examined in lithotomy position. He developed fecal incontinence along with regional sepsis. Defunctioning colostomy by Hartmann`s procedure was carried out. Perineal wound was left open for free drainage, dressing and debridement. When it was clean sphincter repair was carried out under general anaesthesia. The internal anal sphincter was identified as a glistening, white, fibrous structure between the rectal mucosa and the external anal sphincter and was repaired with continuous 2-0 polyglactin sutures. The external anal sphincter was identified as a band of skeletal muscle with a fibrous capsule. It was mobilized sufficiently to gain an overlap of about 2 cm extending the length of anal canal and was secured using 2-0 interrupted polyglactin sutures. Wound was left open to heal by second intention and the patient was, encouraged pelvic floor exercises. After complete healing of perineal wound colostomy was closed. The patient is now completely continent for flatus and faeces.

Category: Case Reports
Keywords: Anus. Sphincteroplasty.

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