OB/GYN, Tripler Army Medical Center, Honolulu, Hawaii, USA
OB/GYN, Evans Army Community Hospital, Ft Carson, Colorado, USA.
BMJ Case Rep. 2021 Jan 26;14(1):e234321. doi: 10.1136/bcr-2020-234321.
A complete perineal wound breakdown of a fourth degree laceration leading to a cloaca is a rare but devastating complication of vaginal childbirth. A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. The discussion describes our surgical approach in the context of a review of the literature.
四度会阴裂伤完全裂开并导致肛膜闭锁是阴道分娩罕见但严重的并发症。一位 32 岁初产妇在分娩后 4 个月出现产科性肛膜闭锁。她接受了术前评估，并在广泛咨询后选择进行手术修复。手术过程以 15 个明确的步骤呈现，并附有照片。修复采用标准方法进行，另外还增加了 3 个步骤。这些步骤包括：（1）将直肠阴道组织分为三个不同的层；（2）将这些层分别附着到重建的会阴体和括约肌上；（3）将提肛肌纳入修复中。修复后 6 周内伤口愈合良好。现在术后 3 年半，患者没有粪便失禁或性功能障碍，仅存在轻微的排便功能障碍。讨论部分结合文献复习，介绍了我们的手术方法。
