Published online Mar 16, 2017. doi: 10.12998/wjcc.v5.i3.124
Peer-review started: June 29, 2016
First decision: August 5, 2016
Revised: November 2, 2016
Accepted: November 21, 2016
Article in press: November 23, 2016
Published online: March 16, 2017
We are reporting the case of a 32-year-old female who had suffered from fecal incontinence (FI). She was born with an imperforate anus and a recto-vaginal fistula; she underwent repair at 6 mo of age. At 29 years of age, she was still fecally incontinent despite extensive pelvic floor reeducation. A magnetic resonance imaging and an anal electromyography were performed. Because her symptoms were considered to be probably due to extra-sphincteric implantation of the neo-anus, a redo was performed of the recto-neo-anal intra-sphincteric anastomosis. A neurostimulator device was subsequently implanted for persistent incontinence. Solid and liquid FI resolved, and her quality of life improved markedly. Combining surgery to correct the position of the neo-anus within the anal sphincter complex and neurostimulation could thus become a new approach in cases of refractory FI for patients with imperforate anus as a newborn. Follow-up into adulthood after pediatric imperforate anus surgery should be recommended for adult patients with persistent FI.
Core tip: Fecal incontinence is frequent among young adults who have suffered from an imperforate anus. This condition needs to be better understood by adult surgeons, and evaluation of the repair is necessary. This case report describes exams done to confirm the abnormal position of the anus in relation to the sphincter complex and what was done to improve the condition of the patient. Surgery and neurostimulation were complementary and dramatically improved the quality of life of this patient.