[Sphincteroplasty in traumatic anal incontinence]

BACKGROUND

Anal incontinence in young women is often caused by sphincter rupture from obstetric injury or anal fistula surgery.

MATERIAL AND METHODS

From 1992 to 1997, 17 women were operated for anal sphincter injury at Aker University Hospital, Oslo, Norway. Data were obtained retrospectively from patient files.

RESULTS

In 13 patients, the anal incontinence was caused by obstetric injury and in four by anal fistula surgery. In all patients the external anal sphincter was repaired with overlap technique. In addition, plication of the puborectalis muscle was performed in 15 patients, perineoplasty in eight, vaginoplasty in one and operation for genital prolapse in one. Nine patients had a temporary loop sigmoidostomy. 12 of 16 patients for whom postoperative symptoms had been recorded, reported improved anal continence. Eight of these had complete anal continence, whereas four still experienced some incontinence for gas and loose stools. On clinical examination, 11 patients had normal resting sphincter pressure and voluntary sphincter contraction. Six had weak voluntary contraction; two of these had normal resting sphincter pressure.

INTERPRETATION

Traumatic anal sphincter injuries in young patients can seriously impair anal function. Results of surgical treatment are satisfactory in most patients.

[Pulmonary plasma cell granuloma. Inflammatory pseudotumor in the lung]

A 62-year-old woman developed minor symptoms of subacute respiratory infection simulating bronchitis. Six weeks later, X-ray of the chest revealed a solitary round infiltration ("coin lesion") in the basal part of the left lung. No diagnosis could be made preoperatively. Thoracotomy demonstrated a plasma cell granuloma. The affected pulmonary segment of the basal part of the upper lobe was resected. There were no clinical nor radiological signs of recurrence five years after the operation.