Case Reports

Management of the anorectal avulsion

Timing of anal reconstruction

Outcome

Mathieson and Mann, 1965 [2]

Primary repair + presacral drainage + sigmoid loop colostomy

Primarily at the first surgery

(hemodynamically unstable)

At 12 months, complete continence

for stool and flatus

Sharma et al., 2000 [3]

Primary repair + presacral drainage + sigmoid loop colostomy

At the first surgery, in the first 48h

(hemodynamically stable)

Discharged after 7 months.

Normal continence

Terrosu et al., 2011 [4]

Anal reimplantation + pelvic drainage tubes + loop transverse colostomy

In the first 24h

(hemodynamically stable)

At 24 months complete continence

Rispoli et al., 2012 [5]

Direct suture not possible, sigmoid loop

colostomy + presacral drainage + traction of the anus with a Foley catheter

Delayed at a second surgery, in the first 36h

(hemodynamically stable)

At 34 months, no incontinence. Anal canal with normal tone but dislocated cranially

Hassani et al., 2013 [6]

Primary repair + presacral drainage + sigmoid loop colostomy

Primarily at the first surgery

(hemodynamically stable)

At 6 months, no physiologic dysfunction on anorectal manometry; anal stenosis

requiring dilatations

Gomes et al., 2013 [7]

Direct repair not possible

Sigmoid loop colostomy + distal loop washouts

Delayed at 72h

On 1 month, no tone of the anal sphincter, then loss to follow-up

Barni et al., 2015 [8]

Anal reimplantation + subcutaneous suction drainage + sigmoid loop colostomy

Primarily at the first surgey

(hemodynamically stable)

Anal stenosis requiring perineal rehabilitation and repetitive anal dilatation

Page et al., 2015 [9]

Reimplantation not possible

Diverting colostomy + perineal washout

At 5th day, completion proctectomy and rectus abdominis myocutaneous flap

Permanent stoma

Cruceru et al., 2016 [10]

Anal reimplantation + pelvic drainage + sigmoid loop colostomy

Delayed at 48h

(hemodynamically stable)

At 6 months no impairment of the anal continence.