LATE SURGICAL TREATMENT FOR CLOACA DUE TO OBSTETRIC TRAUMA

Case Presentation A 63-year-old female presented with complete fecal incontinence for over 35 years. She had two vaginal deliveries in her second decade of life, with obstetric trauma during the second birth, which remained untreated since then. The patient sought medical help late due to recurrent urinary infections, which led to the diagnosis of a perineal lesion described as “cloaca,” and she was referred to the Coloproctology clinic. On physical examination, there was a complete rupture of the perineal body and anterior mucosal rectal prolapse. The ends of the anal sphincter muscles were easily palpable in the anterior quadrants of the anus, close to the coronal line. The patient underwent perineal reconstruction surgery under spinal anesthesia. The rectovaginal septum was dissected, and the fascia of the puborectal muscles was approximated, with reinforcement from the existing fibrosis. The transverse perineal muscle was also identified and reconstructed. An anterior midline anal sphincteroplasty was performed using the overlapping technique. The anterior mucosal prolapse was also corrected via endo-anal suturing. The procedure was conducted after an anterograde colon preparation for better postoperative comfort. The patient was discharged the day after surgery. She had a good immediate and long-term recovery, with improved fecal continence and no longer needing daily pads.

Discussion The most common cause of traumatic fecal incontinence is obstetric injury. Early diagnosis and treatment provide better chances of preventing long-term fecal incontinence. Some cases, especially those not addressed early, develop severe anatomical defects, such as traumatic cloaca, negatively affecting quality of life and health outcomes. In this case, the patient had lived with cloaca for decades, but after surgical correction with a specialized team, there was significant improvement in fecal incontinence.

Conclusion Surgical treatment of fecal incontinence following severe obstetric injury, whether early or late, provides excellent functional and anatomical results, positively impacting the quality of life of these patients and their families.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025