Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene

Patient was an 8-year-old female, previously healthy, who at age 3 suffered from Fournier's gangrene complicated by extensive sphincter and perineal muscle injury.

Initial management consisted of successive surgical debridements and creation of a diverting colostomy.

After healing, patient was left with a patulous anus, no dentate line, and presumed fecal incontinence due to scarring.

Electrical stimulation demonstrated very minimal sphincteric contractions at the skin level.

A skin level anal stricture was present.

Posterior sagittal incision was made all the way to the coccyx to access and release scar tissue.

In the deeper layers, excellent muscle contraction was observed in the muscle complex, parasagittal fibers, and levators.

The identified muscle complex was tacked to the posterior rectum so that when these muscles contract, the rectum will be pulled in and closed.

The surgical technique is analogous to the conclusion of a PSARP (posterior sagittal anorectoplasty) for an anorectal malformation.

It is very important that sutures tacking muscles to rectum not narrow the rectal lumen.

The anoplasty was extended posteriorly to enlarge it.

After muscle tacking, the anoplasty was no longer patulous because the muscles were holding it in.

Post-reconstruction electrical stimulation demonstrated the anus being closed by the sphincteric muscles.

Patient subsequently had their colostomy closed and achieved bowel control.