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Session: ePoster: Benign Anorectal 1 (Sun8)

EP235 - Dirt biking gone wrong: Anal Sphincter Injury requiring Emergent Operative Sphincter Repair

Sunday, May 11, 2025
8:32 AM – 8:37 AM PT
Location: Monitor 3, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Thomas Tritt, MD

    Colorectal Fellow
    RWJ Rutgers
    Stamford Health
    WYCKOFF, NJ, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Kirsten Bass Wilkins, MD FACS FASCRS (she/her/hers)

    Associate Program Director Colorectal Fellowship
    Rutgers-Robert Wood Johnson
    Plainfield, New Jersey, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Thomas Tritt, MD: This individual has no financial relationships with ineligible companies.
Kirsten Bass Wilkins, MD FACS FASCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Anal blunt and penetrating trauma is an uncommon injury. The etiology of injuries include iatrogenic, sex-related, foreign bodies and gunshots, and motor vehicle accidents. In the workup of all injuries to the anal sphincter complex, rectal injury must be excluded. Often this can be done with CT abdomen and pelvis with IV and rectal contrast. However, direct visualization of the rectum endoscopically or in the operating room is the best test for identifying injury. Operative intervention is often focused on debridement to healthy tissue and washout, restoration of normal anatomy with re-approximation of the sphincter muscles, diversion if necessary due to the complexity of the injury or if the patient is hemodynamically unstable. We present a traumatic blunt stretch injury to the internal and external sphincters with an associated rectal mucosal laceration requiring exam under anesthesia, debridement, washout and sphincteroplasty.

Methods/Interventions: 22 YO M presents after a fall off a dirt bike landing on his perineum. He returned home and proceeded to have pain with a bowel movement and blood. He was brought to the emergency room at an outside institution and was transferred to our service due to potential injury to the anal sphincter. The patient was given Zosyn and a tetanus shot. CT Abd/Pelvis w/ IV contrast showed no evidence of rectal injury. Patient was taken to the OR expeditiously and found to have a posterior laceration to his anus with a stretch injury to the internal and external sphincters with decreased tone with associated laceration into the distal rectum.

Results/Outcomes: Edges of the wound were debrided and the wound was irrigated thoroughly. The internal and external sphincter was plicated in an overlapping fashion and the rectal mucosa was closed. The perianal skin was left open. The patient was admitted and given a bowel regimen and treated with IV antibiotics for 2 days. His pain was well controlled, had return of bowel function with no evidence of incontinence. He was sent home on oral antibiotics for 1 week.

Conclusion/Discussion: Anal trauma is a rare condition encountered by colorectal surgeons. We present the successful treatment of a traumatic sphincter complex injury with operative debridement, sphincteroplasty, washout and debridement. New therapeutic options are becoming available to help treat fecal incontinence, sacral nerve stimulators and magnetic anal sphincter are showing promising long term outcomes.

Herzig DO. Care of the patient with anorectal trauma. Clin Colon Rectal Surg. 2012 Dec;25(4):210-3. doi: 10.1055/s-0032-1329391. PMID: 24294122; PMCID: PMC3577610.

Jeganathan AN, Cannon JW, Bleier JIS. Anal and Perineal Injuries. Clin Colon Rectal Surg. 2018 Jan;31(1):24-29. doi: 10.1055/s-0037-1602176. Epub 2017 Dec 19. PMID: 29379404; PMCID: PMC5787399.