Partially avulsed anus in blunt traumatic perineal laceration: Case report

Abstract

Blunt civilian perineal laceration with anorectal avulsion is rare and usually associated with severe pelvic trauma. The principles of management of these injuries consist of repair of the laceration (primarily or secondary), diversion of fecal stream, and presacral drainage of the wound. Unnecessary diversion of fecal stream may add complications and increases patient's morbidity. We report a case of severe blunt traumatic perineal laceration associated with partially avulsed anus which was managed without colostomy. The wound healed completely with preserved anal sphincter function. To our knowledge, no similar cases of anal avulsion were treated without diversion of the fecal stream in the English literature.

Keywords: Anal avulsion; Blunt trauma; Perineum.

Fig. 1

A. Partially avulsed anus showing the anal verge (arrow) with very deep perineal laceration extending posteriorly the natal cleft area (arrowhead). B. Primary repair of the anal sphincter and anal verge (arrow) with drain kept in the anococcygeal area (arrowhead).

Fig. 2

CT scan of the pelvis in coronal view depicting a laceration involving the external anal sphincter on the left side (Red Arrow) sparing the internal anal sphincter. Small air bubble is noted adjacent to the laceration on the left side (Yellow Arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

CT scan of the pelvis in axial views Image A depicting a laceration involving the external anal sphincter on the left side which appears hypodense compared to the rest of the sphincter (Red Arrow). Small air bubble seen adjacent to the laceration on the left side (Yellow Arrow). Image B represents imaginary boundaries of the external anal sphincter (Red Circle) and the internal anal sphincter (Yellow Circle). Such distinction is suboptimal on CT when compared to MRI. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

Image A Trauma CT scan in coronal view depicting a large air containing fluid collection over the left gluteus maximum muscle (arrow). Image B X-ray left femur depicting multiple air pockets (arrows) and hematoma in the soft tissue of the left thigh (arrowhead).