Perineal Body Disruption Following Unrecognized Obstetrical Trauma
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The patient is positioned prone with a urinary catheter in place for this procedure.
The rectum and vagina are contiguous with complete absence of the perineal body.
The anus is correctly located with an intact dentate line but is deficient anteriorly.
Tension sutures are placed on the anterior rectal wall to facilitate dissection from the posterior vaginal wall.
There is no natural tissue plane between the fused rectal and vaginal structures.
Additional tension sutures are placed in the posterior vaginal wall during dissection.
Reaching the areolar plane indicates complete separation of the rectal and vaginal structures.
Perineal body reconstruction is performed once adequate separation of structures is achieved.
The anoplasty involves suturing the anterior rectal wall to the posterior limit of the reconstructed perineal body.
The rectal lumen is preserved because the posterior rectum is not dissected during this repair.