Perineal Body Disruption Following Unrecognized Obstetrical Trauma

A urinary catheter has been placed and the patient is in the prone position. As you can see here, the rectum and the vagina are contiguous, and there is no perineal body. You can see that the anus is correctly located and has a dentate line, however, it appears to be deficient anteriorly. Stitches are placed on the anterior rectal wall, and the dissection begins to separate the anterior rectal wall from the posterior vagina. There is no actual plane as these structures are fused. Further tension sutures are placed in the posterior wall of the vagina, and the dissection continues. Here you can see the areolar plane is reached, which demonstrates complete separation of the two structures. Once adequate separation is achieved, the perineal body is reconstructed, as demonstrated here. Closure of the perineal body is completed, and this is followed by completion of the anoplasty, with the anterior rectal wall being sutured to the posterior limit of the reconstructed perineal body. The lumen of the rectum is not compromised, as the posterior rectum has not been dissected.