Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Patient was previously healthy but 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
Patient healed but was left with a patulous anus and no dentate line and presumed to be fecally incontinent because of scarring
Initial electrical stimulation showed very minimal sphincteric contractions
Patient had a skin level anal stricture
In the deeper layers, excellent muscle contraction was observed
The muscle complex consists of parasagittal fibers and the levators
The surgical technique is analogous to the conclusion of a PSARP for an anorectal malformation, tacking the muscle complex to the rectum
When the reconstructed muscles contract, the rectum will be pulled in and closed
It is very important that the muscle-tacking sutures not narrow the rectal lumen
After reconstruction, the anoplasty is no longer patulous because the muscles are now holding it in
Post-reconstruction electrical stimulation demonstrated the anus being closed by the sphincteric muscles
Patient went on to have their colostomy closed and now has bowel control