EP1096 - Total Internal and External Anal Sphincter Disruption in a 26-Year-old Secondary to a Fall on a Boat Latter

Purpose/Background: Rectal injuries are the least common traumatic organ injuries occurring in 1-3% of cases. Blunt trauma accounts for the second least common mechanism over gunshot wounds. Given the location of the rectum in the pelvis, these injuries are often delayed in diagnosis and can be overlooked. A 26-year-old women presented as a transfer from a rural hospital after a straddle injury on a boat latter. In the emergency department, the patient was hemodynamically stable and was diagnosed with a deep right labial injury and leveled to the operating room (OR) with gynecology.

Methods/Interventions: Colorectal surgery was urgently consulted once in the OR after the patient was found to have a grade 4 sphincter injury, Image 1. The external sphincter was reapproximated using horizontal mattress sutures; complex sphincteroplasty was then performed. The internal sphincter was then reapproximated from deep to superficial. The mucocutaneous junction externally down to the labia majora the dermis was closed using 3-0 chromic sutures to achieve apposition of the skin up to the inferior aspect of the labia majora, completing the anoplasty procedure, image 2. Lastly, a laparoscopic diverting loop ileostomy was created.

Results/Outcomes: The patient had return of bowel function on post-operative day 1 (POD) and was given a regular diet. On POD2 the patient was discharged home once tolerating a diet and ostomy was productive. The patient is doing well 3 months post-operatively, with normal ostomy function, patient recently underwent MR defecography that demonstrated normal findings. She is scheduled for ileostomy reversal in the 2 weeks.

Conclusion/Discussion: The patient suffered a grade 4 sphincter injury, as seen in image 1, the patient had total loss of sphincter tone with anal gaping. The patient declines any discharge or signs of infection in the last 3 months since repair and is continuing to have normal ileostomy output and had a recent normal MRE . This case demonstrates a rare complication of grade 4 sphincter laceration from a fall on a latter of a boat and a potential treatment strategy that led to a good outcome.

Image 1:
Intraoperative picture of grade 4 sphincter laceration
Image 2:
Post sphincteroplasty and anoplasty with labial laceration repaired by gynecology.