title: A novel concept for the surgical anatomy of the perineal body.
abstract: OBJECTIVE
  Perineal body is considered by investigators as a fibromuscular structure that is the site of insertion of perineal muscles. We investigated the hypothesis that perineal body is the site across which perineal muscles pass uninterrupted from one side to the other.
  
  
  METHODS
  Perineal body was studied in 56 cadaveric specimens (46 adults, 10 neonatal deaths) by direct dissection with the help of magnifying loupe, fine surgical instruments, and bright light.
  
  
  RESULTS
  Perineal body consisted of three layers: 1) superficial layer, which consisted of fleshy fibers of the external anal sphincter extending across perineal body to become the bulbospongiosus muscle; 2) tendinous extension of superficial transverse perineal muscle crossing perineal body to contralateral superficial transverse perineal muscle, with which it formed a criss-cross pattern; and 3) tendinous fibers of the deep transverse perineal muscle; the fibers crossing perineal body decussated in criss-cross pattern with the contralateral deep transverse perineal muscle. A relation of levator ani or puborectalis muscles to perineal body could not be identified.
  
  
  CONCLUSIONS
  Perineal body (central perineal tendon) is not the site of insertion of perineal muscles but the site along which muscle fibers of these muscles and the external anal sphincter pass uninterrupted from one side to the other. Such a free passage from one muscle to the other seems to denote a "digastric pattern" for the perineal muscles. Perineal body is subjected to injury or continuous intra-abdominal pressure variations, which may eventually result in perineocele, enterocele, or sigmoidocele.
authors.affiliation: Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. shafik@ahmedshafik.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shafik
authors.forename: Olfat El
authors.initials: OE
authors.lastname: Sibai
authors.forename: Ali A
authors.initials: AA
authors.lastname: Shafik
authors.forename: Ismail A
authors.initials: IA
authors.lastname: Shafik
mesh_terms: D000293:Adolescent; D000328:Adult; D002102:Cadaver; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000601:surgery; D010502:Perineum / Q000033:anatomy & histology* / Q000601:surgery*