Urazowa amputacja odbytu z uszkodzeniem mięśnia zwieracza zewnętrznego odbytu i mięśni pośladków – opis przypadku

*Szymon Głowacki¹, Krzysztof Kicki¹, Małgorzata Kołodziejczak², Walentin Kazakow¹, Henryk Komoń¹

Summary
Rectal injuries mainly result from falls onto sharp objects or happen, together with other numerous injuries, in serious accidents. They are dealt with within emergency service. The authors of the present study describe the case of a 65-year-old male, admitted to hospital in a state of shock, who had suffered extensive buttock, perineum and anal sphincter wounds, including ano-rectal abruption, as a result of a farming accident. The patient was immediately operated on. The extensive buttock wounds were surgically treated. The perineum tissues were reconstructed by piecing the anus and rectus together. The external anal sphincter was sewn up. Laparotomy was performed and abdominal anus exteriorized on the sigmoid. Border necrosis of the ¹/₃ of the sewn anus perimeter occurred during the post-operation period. The patient was released on the 13th day after the operation to be supervised ambulantly. After the complete recovery the patient was sent to a reference centre, where he underwent specialistic examination, both graphic and functional: ultrasonographic transrectal examination, colonoscopy, and procto-manometry. The patient was qualified to have the continuity of his gastrointestinal tract reconstructed. 5 months after the first operation the continuity of the gastrointestinal tract was reconstructed. For the first 4 weeks after the operation the patient reported involuntary loss of gas. Biofeedback therapy was involved. Now, 4 months after the second operation, the patient has regained total control over fecal continence. Conclusions: 1. Extensive rectal injury may require treatment both from the perineum and from the abdomen through laparotomy. 2. In case of rectal injuries combined with anal sphincter injuries proper temporary surgical treatment is not sufficient, but it should be followed by a number of functional examinations in order to evaluate the continence objectively as well as – in most cases – biofeedback. Cooperation between particular specialists is essential for a successful therapy.

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