1. This document discusses anal injuries from trauma and their identification, which requires a high index of suspicion, especially in cases of penetrating trauma to the perineum, impalement rectal injuries, pelvic fractures, or physical assault. 2. It presents a case of a 25-year-old male patient who was in an accident involving his tractor tire overriding his left thigh and pelvis. 3. It then covers types of anal sphincter injuries like partial tears, complete tears, lacerations, and injuries to the internal or external sphincter. Identification involves a history of trauma and symptoms like anal tone laxity, incontinence, and abnormal anorectal manometry and pud

1. 1
Dr Awaneesh Katiyar
M.Ch. Trauma Surgery and Critical Care
AIIMS, Rishikesh , India.

2.  In trauma identification of anal injury- comes from
high index of suspicion.
(always rule-out in secondary survey)
 penetrating trauma perineum
 Impalement rectal injury/ pelvic fracture .
 Physical assault
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3. 25 yrs. male patient met with an accident –
overriding of front tyre of the tractor left
thigh and pelvis
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6.  Partial tear
 Complete tear
 Laceration
 Internal –sphincter
 External - sphincter
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7.  History of trauma – most commonly penetrating
 Laxity of anal tone
 Incontinence – flatus/ feces
 For physiological function –
Anorectal manometry and
Pudendal nerve latency test
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8. Type Reconstructions
Partial tear Repair
(sphincteroplasty)
Complete tear 1. End to end
2. Overlapping
With or without Levatorplasty /
internal sphincter repair
Laceration (opposition of tissue not
possible / failed repair)
Anal sphincter Reconstruction
(neo-sphincter)
1. Dynamic gracioplasty
2. Gluteoplasty
3. Artificial Anal sphincter
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11. When primary reconstruction of
anal sphincter is not possible
Dynamic vs Adynamic
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Adynamic and dynamic muscle transposition techniques for
anal incontinence; Goran Barisˇic´* and Zoran Krivokapic;
Gastroenterology Report 2 (2014) 98–105,

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Implantation of SphinKeeperTM: a new artificial anal sphincter C. Ratto,corresponding author L. Donisi, F. Litta, P. Campennì, and A.
Parello;Tech Coloproctol. 2016; 20: 59–66.

14.  Sacral nerve stimulation (S3/S4)
 Island advancement flap ano-plasty
 Bio-injectable / sphincter bulking agent
 Radiofrequency stimulation
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Surgical approaches to fecal incontinence in the adult G. Meurette∗, E. Duchalais, P.-A.
Lehur; Journal of Visceral Surgery (2014) 151, 29—39

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• In Trauma patients – most of the patients required colostomy for healing of
wound if associated with large wound/ even after .
• Anal sphincter repair vs stoma
- Anal sphincter reconstruction is always preferred over stoma
(no prospective meta-analysis or systemic review are found )
QOL, sexual life, depression episodes, are founds to be less in anal sphincter repair

17. Thank you ..
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