SURGICAL-TREATMENT OF TRAUMATIC CLOACA

PURPOSE: This study was designed to evaluate the repair of traumatic c loaca and determine the satisfactory outcome as determined by improvem ent in the continence mechanism of patients. METHODS: Forty-four patie nts were entered in this study during a 14-year period. The majority o f traumatic cloaca occurred secondary to obstetric injury, most freque ntly during the first childbirth. No definite medical illnesses precip itated the occurrence of traumatic cloaca. Only two patients had diabe tes mellitus, and one patient had prior radiation. All patients underw ent surgical repair using puborectalis interposition and sphincteropla sty and perineal body repair, approximating the internal and external sphincter fused bundles and transversus perinei muscles in a vest-over -pants manner. Average stay in the hospital was less than three days, and postoperative morbidity was minimal. One patient had minor postope rative bleeding, which was corrected with cauterization. One patient h ad a superficial subcutaneous infection, which was drained on the 15th postoperative dap. RESULTS: Majority of patients regained excellent c ontrol of continence to both flatus and feces. Four patients had unsat isfactory control to passage of flatus. One patient had unsatisfactory control to passage of liquid stool in addition to flatus. All five pa tients improved, with very satisfactory results, following an exercise program and biofeedback therapy. Six of 12 patients who had perineal discomfort before the surgical procedure, with associated dyspareunia, were the most dissatisfied subgroup in the series, Exact mechanism fo r perineal discomfort is unclear at this point.