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CC BY 4.0 · European J Pediatr Surg Rep. 2024; 12(01): e90-e94
DOI: 10.1055/a-2487-5249
Case Report

Anal Sphincter Reconstruction Using the Posterior Sagittal Approach for Pediatric Perineal Trauma

Julia Ann Ryan
1   Department of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
2   School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, United States
,
Thomas O. Xu 
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Christina Ho
4   Department of Urology, Children's National Medical Center, Washington, District of Columbia, United States
,
Briony K. Varda
5   Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
,
Veronica Gomez-Lobo
6   Division of Pediatric and Adolescent Gynecology, Children's National Hospital, Washington, District of Columbia, United States
7   Department of Pediatric and Adolescent Gynecology, National Institute of Child Health and Human Development, Rockville, Maryland, United States
,
Allison Mayhew
8   Department of Pediatric and Adolescent Gynecology, Children's National Medical Center, Washington, District of Columbia, United States
,
Erin Teeple
1   Department of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, United States
,
Andrea Badillo
9   Department of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Christina Feng
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Marc A. Levitt
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
› Author Affiliations Funding This research was supported by the U.S. Department of Health and Human Services through the National Institutes of Health (NIH), specifically the National Institute of Child Health and Human Development (NICHD), under the grant NICHD Z1A HD008985.
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Abstract

Traumatic perineal injuries are rare but can result in significant morbidity, particularly when the anal sphincter is injured. The management of such injuries in the pediatric population is rarely noted in the literature. We aimed to describe reconstruction in such patients using lessons learned in reoperative anorectal malformation surgery. This is a single-institution retrospective case series of three pediatric patients who were referred to our institution with pelvic trauma who underwent anal sphincter reconstruction. Three patients aged 5 (female), 12 (male), and 13 (female) years were referred for reconstruction following pelvic trauma involving the anal sphincter, perineal body, and genitourinary system. All three underwent multidisciplinary evaluation with urology and gynecology (for females) and a subsequent repair with anal sphincter reconstruction utilizing a posterior sagittal approach. Two patients had ostomy reversal with appendicostomy for antegrade continence enemas and regained voluntary fecal control. The third patient is awaiting colostomy reversal but has regained volitional urinary control after urethral reconstruction. The experience gained from using the posterior sagittal anorectoplasty approach in reoperations for patients with anorectal malformations can be applied to cases of rectal trauma. Key aspects include mobilizing the rectum, repairing the sphincters, and placing them around the anus, and in females, reconstructing the perineal body. Pediatric pelvic trauma can cause devastating disruptions of physiology and are difficult to treat. Experience from reoperations for anorectal malformations can be applied to these cases, including the use of a multidisciplinary team and posterior sagittal approach.

Keywords

perineal trauma - sphincter reconstruction - posterior sagittal approach


Publication History

Received: 10 September 2024

Accepted: 17 November 2024

Accepted Manuscript online:
25 November 2024

Article published online:
19 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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