Extensive Perineal Injury Managed Through a Multidisciplinary Approach: A Case Report
Main Article Content
Abstract
Background: Severe perineal injury is a rare but potentially life-threatening form of trauma; most commonly associated with motor vehicular crashes and blunt trauma. These injuries often involve multiple anatomical structures and are frequently complicated by contamination, infection, and functional impairment. Successful management depends on early recognition, accurate anatomical assessment, and a well-coordinated multidisciplinary team approach.
Case Presentation: We report a case of severe perineal injury in a trauma patient who sustained extensive soft-tissue damage to the perineum with involvement of the anal sphincter complex. The injury posed significant challenges due to the risk of sepsis, fecal contamination, and associated urogenital involvement.
Management and Outcome: Initial management prioritized prompt resuscitation and stabilization, with attention to life-threatening injuries. Definitive treatment involved urinary diversion through suprapubic cystostomy, fecal diversion via colostomy, and coverage of the perineal defect using a split-thickness skin graft. The anal sphincters were managed conservatively and allowed to heal by secondary intention. The patient demonstrated satisfactory wound healing, preserved continence, and an acceptable functional outcome on follow-up.
Conclusion: Severe perineal injuries require meticulous anatomical evaluation and staged management within a multidisciplinary framework. Early diversion procedures and appropriate reconstructive techniques can significantly reduce complications and improve functional outcomes.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
How to Cite
References
⦁ Slack CC. Friction injuries following road accidents. Br Med J. 1952; 2: 262-264
⦁ Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep. 2013; 110: 603-608.
⦁ De Korte N, Dwars BJ, van der Werff JF. Degloving injury of an extremity. Is primary closure obsolete? J Trauma. 2009; 67: E60-61.
⦁ Ameh EA. Anorectal injuries in children. Paediatr Surg Int 2000;16:388-91
⦁ Demetriades D, Salim A. Colon and rectal trauma and rectal foreign bodies. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, editors. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer Science & Business Media; 2007. p. 322-34
⦁ Burak VU, Ahmet T, Abdullah O, Omer U, Ibrahim A, Mesut G, et al. Is Ostomy still mandatory in rectal injuries? Int Surg 2013; 98: 300-3
⦁ Mathes SJ, Nahai F. Clinical Applications for Muscle and Musculocutaneous Flaps (2nd edition). C.V. Mosby Company, St. Louis, 1982
⦁ Levin LS. “The Reconstructive Ladder: An Orthoplastic Approach.” Orthopedic Clinics of North America, 1993; 24(3): 393–409.
⦁ Simman R. “Wound closure and the reconstructive ladder in plastic surgery.” Journal of the American College of Certified Wound Specialists, 2009; 1:6-11.
⦁ Cahill C., Fowler A., Williams L.J. The application of incisional negative pressure wound therapy for perineal wounds: a systematic review. International Wound Journal, 2018.
⦁ Negative pressure wound management in perineal wound status post abdominoperineal resection and extralevator abdominoperineal excision: A meta-analysis. (2025). PubMed.
⦁ Negative pressure wound therapy and split thickness skin graft aided in extensive perineum necrotizing fasciitis. BMC Surgery. ⦁ SpringerLink
⦁ Chuang TY, Tingey P, Malik H, Srinath H, Sax A. "A novel approach of non-surgical faecal diversion." Int J Case Rep Images (2018): 00971.
⦁ Brown AM, Rubayi S. "Reconstructive Surgery of the Perineal and Anal Area after trauma with Lower Extrimity Flap." Clin Surg (2020): 5: 2964.
⦁ Scott S M, Gladman M A. "Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function." Gastroenterol Clin North Am 37.3 (2008): 511-38. Document.