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. 2023 Dec 27;14(1):68.
doi: 10.3390/diagnostics14010068.

Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence

Michele Orsi  1 , Giuseppe Cappuccio  1   2 , Hayato Kurihara  3 , Gabriele Rossi  1 , Giuseppe Perugino  1 , Enrico Ferrazzi  1   2 , Carmela Coppola  1
Affiliations

Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence

Michele Orsi et al. Diagnostics (Basel). .

Abstract

We present the case of a 36-year-old primigravida who gave birth to a 3200 g baby by vacuum-assisted (Kiwi OmniCup™) operative vaginal delivery with mediolateral episiotomy. A "y"-shaped perineal tear with a grade IIIC obstetric anal sphincter injury (OASI) was diagnosed and repaired. Two days after delivery, in the absence of suture dehiscence, she started experiencing complete anal incontinence. A decision was made in association with a proctologic surgeon for an early secondary repair. Before surgery, a Three-dimensional transperineal ultrasound (TPUS) was performed. The exam revealed a major defect of the external anal sphincter at the 11 o'clock position. This allowed for the reopening of only a circumscribed area of the perineal suture and repair of the sphincters using the end-to-end technique. The symptoms regressed completely, and follow-up TPUS demonstrated the gradual wound healing process. Anal incontinence, secondary to obstetric anal sphincter injury (OASI), has a severe negative impact on women's quality of life. TPUS is an effective method to detect sphincter defects and monitor the healing process. This report investigates the feasibility of identifying the sphincter tear in an incontinent puerperal patient without suture dehiscence in order to target early secondary repair while minimizing its extent. TPUS has proven a safe and effective tool to guide early secondary repair of symptomatic OASI complications while minimizing the invasiveness of the procedure. Multidisciplinary management is crucial to ensure the adequate standard of care.

Keywords: 3D imaging; anal incontinence; early secondary repair; multidisciplinary management; obstetric anal sphincter injury; pelvic floor disorders; ultrasonography.

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Conflict of interest statement

The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Three-dimensional transperineal ultrasound performed before secondary repair. The angle highlights the external anal sphincter injury at the 11 o’clock position.
Figure 2
Figure 2
Three-dimensional transperineal ultrasound performed one month after secondary surgery. The anal sphincter repair is indicated by the yellow circle.
See this image and copyright information in PMC

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