Repair of a fourth-degree laceration requires approximation of the rectal mucosa, internal anal sphincter, and external anal sphincter Figure 9. An alternative technique is overlapping repair of the external anal sphincter. The artificial bowel sphincter is an effective solution if successful implantation can be achieved; the need to remove the device due to infection remains common and it is unclear whether those with a failed device have worse function as a result of the attempted implantation. The sutures are continued to the anal verge i. These injuries do not require immediate repair; hence, an inexperienced physician can delay the procedure for a few hours until appropriate support staff are available. Repair of bulbocavernosus muscle with single interrupted suture.
The sphincter may be retracted laterally, and placement of Allis clamps on the muscle ends facilitates repair.
Case Reports in Surgery
Blunt and penetrating injuries to the anus and rectum are uncommon. The main principles on which the practice of suturing is based is to control bleeding, minimise the risk of infection, assist the wound to heal by primary intention and achieve correct anatomical alignment. Get immediate access, anytime, anywhere. Management of transpelvic gunshot wounds. Civilian extraperitoneal rectal gunshot wounds: The literature contains little information on patient care after the repair of perineal lacerations.