Civilian and war injuries of the perineum and anal sphincters

Abstract

Patients with pelvic and perineal non-obstetric trauma were studied to determine the clinical outcome in relation to faecal continence. Between 1980 and 1992, 65 patients were referred for post-traumatic assessment of the anal sphincters and continence mechanism. All patients were continent before trauma. Using clinical examination, manometry, concentric-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 considered to be intact in nine patients. At a median follow-up of 12 months 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 patients were lost to follow-up. A good clinical result was associated with a significant increase in resting pressure (median increase 15 cmH2O; P = 0.017) and squeeze pressure (median increase 35 cmH2O; P = 0.001). At postoperative assessment three patients with a poor outcome were shown to have a second unsuspected contralateral sphincter defect that had not been repaired. Physiological and endosonographic investigation combined with late surgical repair leads to a good outcome in most patients with traumatic sphincter damage.