Traumatic cloaca repair. Case report a literature review.

Abstract

Introduction: Traumatic cloaca is a complete disruption of the anterior anal wall and rectovaginal septum generally as a complication of a vaginal delivery. It is uncommon and highly disabling. Although surgery is indicated in all cases there is no agreement about the best procedure.

Case report:  a 17 year-old primiparous woman with severe incontinence achieving a Cleveland Clinic Florida Score of 19 and a perineal cloaca is presented. Surgical repair was performed 9 months after childbirth. During surgery remaining rectovaginal septum was dissected, both puborectalis muscles were sutured to midline to rebuild perineal body. Anal sphincter was repaired using overlap technique, and both anal and vaginal mucosa were closed. No diverting ostomy was performed. Patient had a good postoperative course, being discharged at postoperative day 4. Actually at long term follow up she still has a good continence.

Discussion: The best technique for repairing traumatic cloaca is still topic of debate. We did not find high level evidence about the use of flaps to repair cloaca deformities, moreover midline closure has similar or better morbidity rates than more complex flap procedures. There is no advantage in performing diverting ostomy although leads to a worse quality of life. There is data about a long term decline on continence after surgical repair.

Conclusion: a case of traumatic cloaca layered repair technique is presented. This technique has acceptable postoperative complication rate and very good functional outcome.