Traumatic cloaca

Traumatic cloaca

Kunal Kochar, MD, Gopi Tripuraneni, MD, Jasna Coralic, MD, Jed F Calata, MD, John Park, MD, Slawomir Marecik, MD, Leela Prasad, MD

Advocate Lutheran General Hospital, Division of Colon and Rectal Surgery

A traumatic cloaca refers to perineal injury that involves disruption of the perineal body, anterior division of the anal sphincter complex and disruption of the rectovaginal septum. It is usually secondary to obstetric injuries with a reported incidence of 0.003% of all vaginal deliveries. Various techniques of repair including X flaps, modified lotus petal flap and skin grafting have been described in literature. A diverting stoma may or may not be done at the same time. The repair is usually done after a delay of 6-12 weeks, to allow the inflammation to subside and for clear definition of tissue planes. We report a case of self inflicted traumatic cloaca in a non-pregnant, 27 year old female, who underwent a successful immediate repair. Primary repair was achieved with different coloured sutures to aid in identifying distinct tissue planes and a biological mesh was placed in the recto-vaginal septum for added support. To the best of our knowledge an immediate repair of traumatic cloacae has not been previously reported.

Fig 1: Lone star exposure and suture labeled layers

Fig 2: Cloacal repair, immediate post operative

Fig 3: Cloacal repair, four weeks follow up