Improvement of Recto-anal Function after Successful Two-tage Surgery for External Injury-related Anal Sphincter Rupture: A Case Report

A 24-year-old woman was admitted with a diagnosis of rectal, vaginal and bladder rupture due to falling from a jet ski. Suturing was carried out as extensively as possible, and sigmoid colostomy with drainage of the retroperitoneal space was performed. The patient was referred to our hospital 3 months after the accident due to the absence of recto-anal function, with retained bladder function. Though defecography demonstrated complete incontinence due to poor retention of the contrast medium at rest, sphincter training was started because slight puborectal muscle contractions were identified and electromyographic contraction waves were detected in part of the injured sphincter. Two months later, an increase in the maximal voluntary pressure, elongation of contrast retention time and contractions of the puborectal muscle were observed. On ultrasonography, scarring had developed in the ruptured sphincter, and at 6 months after injury, anterior sphincteroplasty was performed. At 9 months, sphincteroplasty with an artificial fascia and posterior sphincteroplasty were performed. At 15 months, the parameters of the anorectal sphincter had improved as follows: contrast retention time increased to 2 min, maximal resting pressure of 20mmHg, maximal voluntary pressure of 90mmHg, rectal sensory threshold of 15ml, urge sensation volume of 35ml and maximum tolerated volume of 75ml. The stoma was closed at 17 months after colostomy, and at present, the patient is in good health with no signs of incontinence.