Management of severe iatrogenic perineal injury

Abstract

Perineal injuries are uncommon. More uncommon are severe perineal injuries. This is attributed to the relative protection of the perineum by the bony pelvis. Common causes of perineal injury include injuries from motor vehicular accidents, fall from height, foreign body insertion into the perineum, injuries from rape, and penetrating external trauma. The management of severe perineal injury entails addressing any life-threatening condition in the patient first and, subsequently, the perineal injury. The perineal injury can be repaired primarily with or without colostomy or colostomy carried out alone without primary repair. We present four cases of severe perineal injury managed by colostomy alone without primary repair of perineal soft tissue or anal sphincters. The anal sphincters and perineal soft tissues healed secondarily and sealed without any need for repair with good outcome.