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Complex Case Spotlight
Surgical Reconstruction Resolves Cloaca-Like Deformity After Obstetric Trauma
A Cloaca-Like Deformity Secondary to Obstetric Trauma
A preoperative physical exam revealed an open defect in the perineal body, anal sphincter complex, and rectovaginal septum measuring 6 centimeters in length and representing a cloaca.
A clear demarcation of vaginal and anal mucosa.
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Endoanal Ultrasound Reveals Full Extent of Clinical Findings
An endoanal ultrasound, the preferred imaging for surgical planning, confirmed findings of the patient’s digital rectal exam, revealing significant separation of the external from the internal anal sphincter.
Endoanal ultrasound demonstrates the degree of separation of the external (EAS) and internal anal sphincters (IAS). Yellow dash marks indicate dehiscence of the sphincter complex 150 degrees.
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Re-Approximation of the Rectal-Vaginal Structures
For the reconstruction, an initial horizontal incision was made and the rectum and vagina separated. The internal and external anal sphincter were identified and dissected, then re-approximated.
Surgeon’s view of the reconstruction to re-approximate the internal (A) and external (B) anal sphincter.
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A Successful Reconstruction
Once the internal and external sphincter were repaired, the previously mobilized rectal mucosa was advanced under the reconstructed sphincter and attached to the perianal skin. The tissues were closed and a drain was placed.
Surgeon’s view of the completed cloacal repair, with drain in place.
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