CIVILIAN AND WAR INJURIES OF THE PERINEUM AND ANAL SPHINCTERS

Patients with pelvic and perineal non-obstetric trauma were studied to determine the clinical outcome in relation to faecal continence. Betw een 1980 and 1992, 65 patients were referred for post-traumatic assess ment of the anal sphincters and continence mechanism. All patients wer e continent before trauma. Using clinical examination, manometry, conc entric-needle electromyography and most recently anal endosonography, external sphincter defects were identified in 56 patients, of whom 52 underwent overlapping sphincter repair. The external sphincter was con sidered to be intact in nine patients. At a median follow-up of 12 mon ths a good result (continence grades 1 and 2) was achieved in 36 of 52 patients and a poor outcome (continence grades 3 and 4) in ten; six p atients were lost to follow-up. A good clinical result was associated with a significant increase in resting pressure (median increase 15 cm H(2)O; P=0.017) and squeeze pressure (median increase 35 cmH(2)O; P=0. 001). At postoperative assessment three patients with a poor outcome w ere shown to have a second unsuspected contralateral sphincter defect that had not been repaired. Physiological and endosonographic investig ation combined with late surgical repair leads to a good outcome in mo st patients with traumatic sphincter damage.