ABSTRACT

According to statistical data, the most common anal sphincter injuries have obstetric aetiology (obstetric anal sphincter defect) or are of iatrogenic nature (fissurectomy, fistulectomy). Apart from perineal repair, including third- or fourth-degree injuries, performed directly after childbirth, the majority of such defects are treated in the course of scheduled procedures. Acute anal injuries resulting from sexual abuse and anal rape, foreign bodies and accidental injuries (e.g. by explosions, impalements, car accidents, etc.) constitute a separate diagnostic and therapeutic problem. Contrary to scheduled procedures, acute anal sphincter injuries are frequently treated in clinics that do not possess appropriate diagnostic base and experience in anal sphincter repair. The article presents the principles of diagnosis and management of acute anal sphincter injuries. The patient is always hospitalised and in the majority of cases, undergoes a surgery. The diagnostic process encompasses: interview, general physical and anorectal examinations, which frequently have to be conducted under anaesthesia, as well as basic laboratory tests: blood group, complete blood count, electrolytes, coagulation parameters and urinalysis. Additional diagnostic examinations include: abdominal x-ray, abdominal ultrasound and, if possible, transrectal ultrasound. The best functional effects are obtained if the muscles are sutured directly after the injury. If the sphincter defect is extensive, or the patient’s condition is severe, or if the injury concerns multiple organs, a stoma should be performed. Similarly, if the surgeon has no experience in anorectal procedures, a stoma should be performed and the patient should be referred to a clinic with greater experience in coloproctology. The management in the case of scheduled sphincteroplasty is different. It should be preceded by functional and imaging diagnostic examinations.