Surgical repair of traumatic cloaca: a modified technique.

AIM: A modified repair technique for traumatic cloaca caused by obstetric anal sphincter injury was evaluated, and its feasibility and functional outcome were investigated. METHODS: A retrospective review of 23 consecutively enrolled patients diagnosed with traumatic cloaca who underwent the modified repair technique between September 2010 and August 2018 was performed. Demographic, clinical feature, operative and follow-up data were recorded. RESULTS: The patients diagnosed with traumatic cloaca who underwent surgical repair after obstetric anal sphincter injury had a median time from obstetric injury of 24 (12-35) years. The median preoperative Wexner faecal incontinence score was 16 (14-17). The postoperative hospital stay was 6 (6-7) days. The median postoperative Wexner faecal incontinence score decreased to 2 (2-3). The anal resting pressure increased from 9.00 (5.25-11.50) mmHg to 56.00 (55.00-65.75) mmHg (P < 0.01) and the anal squeeze pressure increased from 29.00 (22.50-33.20) mmHg to 110.00 (96.20-121.50) mmHg (P < 0.01) at 2 months after the repair. Sixteen patients completed the Faecal Incontinence Quality of Life Scale questionnaire, and there were significant improvements 1 year after surgical repair in lifestyle (3.10 [2.60-3.70] vs 2.60 [1.90-3.00], P < 0.01), coping/behaviour (3.38 [2.57-3.44] vs 2.33 [1.89-3.00], P < 0.01), depression/self-perception (3.11 [2.27-3.44] vs 2.33 [1.89-3.00], P < 0.01) and embarrassment (3.33 [2.75-3.67] vs 2.33 [2.33-3.00], P < 0.01). No patient presented rectovaginal fistula postoperatively within the median follow-up period of 24 (12-48) months. CONCLUSIONS: The modified repair technique for traumatic cloaca is feasible and achieves good functional outcomes and improved life quality.

Delayed Reconstruction of a Traumatic Cloaca Following Obstetric Anal Sphincter Rupture.

Permanent communication between the rectum and the vagina along with full thickness of anal sphincter faults can be a result of an unsuccessful primary repair of fourth degree obstetric trauma. This results into complete fecal incontinence and impaired quality of life. Anterior overlapping sphincteroplasty can be chosen as a method of treatment for fecal incontinence due to obstetric injuries. However, large perineal body reconstructions are generally pretty challenging tasks for surgeons. What we will describe here for the repair of a traumatic cloaca, occurred 23 years ago during vaginal delivery, is the use of a transpositional flap following overlapping sphincteroplasty. Anatomic recovery and fecal continence restoration have been accomplished completely by a follow-up of 24 months.

Outcomes following repair of traumatic cloacal deformities.

BACKGROUND: Severe obstetric injury can result in a defect similar to a congenital cloacal deformity, with associated faecal incontinence and sexual dysfunction. The aim of this study was to assess the efficacy of surgical repair of such injuries. METHODS: Patients were identified retrospectively from hospital records. Long-term follow-up data were collected by telephone interview. RESULTS: Outcomes in 31 consecutive patients seen over a 14-year period were reviewed. An overlapping external sphincter repair, with repair of the anorectum and vagina, was performed in 29 patients. Detailed long-term follow-up data were available for 20 patients at a median of 5 years after surgery. Three patients had a stoma at presentation. Surgical repair reduced incontinence to solid stool from seven of 17 to none of 20 patients, to liquid stool from 14 of 17 to ten of 20, and to flatus from 17 of 17 to 12 of 20. Nine patients reported improvement in sexual function. CONCLUSION: Surgical repair of a cloacal injury is associated with significant improvements in faecal incontinence and sexual function. Outcomes are similar to those seen with repair of less severe injuries, and may be maintained in the long term.

Overlapping sphincteroplasty and modified lotus petal flap for delayed repair of traumatic cloaca.

Traumatic cloaca is a disabling condition characterized by disruption of the perineal body, anterior sphincter tears and loss of the distal rectovaginal septum. Anterior overlapping sphincteroplasty is the method of choice to treat faecal incontinence caused by obstetric injury. However, reconstruction of large perineal body defects may be a challenging task for surgeons. Herein we describe the successful use of a modified lotus petal flap following overlapping sphincteroplasty to repair a traumatic cloaca that had occurred during vaginal delivery 20 years earlier. After 3 months of follow-up and ileostomy closure, the patient had a good aesthetic result and only minor faecal incontinence episodes not requiring pads, fully recovered urinary continence and a significant improvement in her quality of life.

Individual production differences do not explain cannibalistic behaviour in laying hens.

1. Sixty-three laying hens were collected from 5 commercial farms experiencing outbreaks of cannibalism. It is known that cannibalistic behaviour varies strongly between hybrids and between individuals of the same hybrid. The aim of this study was to test specific hypotheses about the causation of cannibalism by comparing matched individuals varying in their cannibalistic behaviour. 2. To investigate feed efficiency, egg production and feed consumption, data were collected over 30 d. Nutrient deficiencies have been associated with outbreaks of cannibalism and we hypothesised that cannibals are more feed efficient than their flock mates and, therefore, more susceptible to transient nutrient deficiencies or imbalances that trigger cannibalistic behaviour. 3. Video recordings were made of victims of cloacal cannibalism and their matched controls during oviposition. Victims were expected to have longer oviposition durations and a higher incidence of short-term cloacal prolapses than controls, because the starting point for cannibalism is often suggested to be pecking at the red mucosa of the victim during, or just after, oviposition. 4. Oviduct swab samples were taken from surviving victims of cloacal cannibalism and their matched controls 4 weeks after the cannibalistic attack. If peck wounds provide a route for subsequent bacterial invasion of the reproductive tract, victims would be expected to have greater bacterial colonisation of the oviduct. 5. Mortality within each matched trio was recorded over a 23-month period after the cannibalistic attack. Victims that survived a cannibalistic attack were expected to have reduced longevity compared to controls and cannibals. This could occur if they developed secondary infections as a result of the cannibalistic attack, or if they had poorer health even before the attack. 6. No significant differences were found between cannibals, victims and controls in feed efficiency or any of the production variables measured. Victims of cloacal cannibalism did not expose their cloacal mucosa more, or for longer, than matched control hens during oviposition, and had no more bacteria in their oviduct. Victims tended to die sooner than their matched cannibals or cannibals during a 23-month period after a cannibalistic attack.

Gross appearance of turkey cloacae before and after single or multiple manual semen collections.

The gross appearance of the turkey cloaca was examined before and after single or multiple semen collections. All cloacae exhibited some degree of hemorrhage formation, the extent of which was dependent upon 1) frequency of semen collection, 2) number of cloacal strokes, and 3) individual differences in semen collectors' techniques. Cloacae of males subjected to multiple semen collections of more than four cloacal strokes per semen collection were the most severely injured. Cloacae examined three days after the last semen collection were nearly normal in appearance. It is suggested that cloacal hemorrhages resulting from semen collection can be minimized by 1) reducing the number of cloacal strokes per semen collection to one or two and 2) using the correct hand placement and pressure on the cloaca during the cloacal strokes.

Histology of turkey papillae after manual semen collection.

Papillae from mature turkey males were removed before and after semen collection and examined by light microscopy. The surface mucosa consisted of deeply folded columnar epithelial cells and a discontinuous layer of basal cuboidal cells. Underlying this layer was a lamina propia of loose connective tissue containing fibroblasts, fibrous elements, and to a lesser extent, plasma cells, lymphocytes, and macrophages. A pseudostratified columnar epithelium consisting of nonsecretory cells lined the lumen of the papillae. The accompanying lamina propria was thin but highly vascular and included fibroblasts and macrophages. Occupying most of the space between the two mucosae was a smooth muscle layer. Immediately after semen collection capillaries throughout the papillae were dilated and congested with red blood cells (RBCs). Scattered throughout the papillae were extravascular RBCs, suggestive of extensive primary hemorrhage. Although heterophils and macrophages were observed throughout the papillae 24 hr after semen collection, only macrophages were involved in the phagocytosis of extravascular RBCs. Macrophage phagocytic activity was evident at 48 hr and occasionally 72 hr after semen collection. By 72 hr few extravascular RBCs were observed.