Traumatic posterior anal injury requiring a sphincteroplasty without diversion: a case report

Abstract

Introduction and importance: The anal sphincters may be divided by direct anal trauma or by severe pelvic injuries. Clinical assessment of traumatic anal injury may suffice in determining the sphincter defect in resource-limited settings where endoanal ultrasonography is not available. As long as about half the sphincter ring remains active there is a good chance of restoring satisfactory fecal continence following an overlapping sphincteroplasty. Case presentation: A 25-year-old heterosexual African man was admitted as an emergency following gunshots to the abdomen and pelvis. He underwent small bowel resection, and a delayed repair of a discrete 50% posterior anal sphincter complex injury (grade 3b) without a diverting stoma. Clinical discussion: The case presented the successful repair of a discrete posterior anal sphincter damage from a gunshot that was not total but sufficient to cause appreciable loss of anorectal control. The preoperative clinical assessment correlated well with the intraoperative assessment of the sphincter injury. Following an overlapping sphincteroplasty, the patient maintained continence at 1-year follow-up. Conclusion: In resource-limited settings, preoperative clinical assessment may correlate well with the intraoperative assessment of anal sphincter injury and, thus allow a safe and efficacious repair.