Surgical repair of an obstetric cloaca with review of the literature
A complete perineal wound breakdown of a fourth degree laceration leading to a cloaca is a rare but devastating complication of vaginal childbirth. A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following ext...
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description | A complete perineal wound breakdown of a fourth degree laceration leading to a cloaca is a rare but devastating complication of vaginal childbirth. A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. The discussion describes our surgical approach in the context of a review of the literature. |
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A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. The discussion describes our surgical approach in the context of a review of the literature.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-234321</identifier><identifier>PMID: 33500293</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Anal Canal - injuries ; Anal Canal - surgery ; Case reports ; Cicatrix - surgery ; Delivery, Obstetric ; Dissection ; Fecal Incontinence ; Female ; Humans ; Innovations in Treatment ; Lacerations - physiopathology ; Lacerations - surgery ; Literature reviews ; Obstetric Labor Complications - physiopathology ; Obstetric Labor Complications - surgery ; Perineum - injuries ; Perineum - surgery ; Plastic Surgery Procedures - methods ; Pregnancy ; Skin ; Surgery ; Surgical Wound Dehiscence - physiopathology ; Surgical Wound Dehiscence - surgery ; Sutures ; Vagina ; Vagina - injuries ; Vagina - surgery</subject><ispartof>BMJ case reports, 2021-01, Vol.14 (1), p.e234321</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. 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A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. 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A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. 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subjects | Adult Anal Canal - injuries Anal Canal - surgery Case reports Cicatrix - surgery Delivery, Obstetric Dissection Fecal Incontinence Female Humans Innovations in Treatment Lacerations - physiopathology Lacerations - surgery Literature reviews Obstetric Labor Complications - physiopathology Obstetric Labor Complications - surgery Perineum - injuries Perineum - surgery Plastic Surgery Procedures - methods Pregnancy Skin Surgery Surgical Wound Dehiscence - physiopathology Surgical Wound Dehiscence - surgery Sutures Vagina Vagina - injuries Vagina - surgery |
title | Surgical repair of an obstetric cloaca with review of the literature |
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