title: Repair of a traumatic cloaca after obstetric anal sphincter injury.
abstract: OBJECTIVE
  Unsuccessful primary repair of fourth-degree obstetric trauma can lead to permanent communication between the rectum and the vagina, which, in association with full-thickness anal sphincter defects, is characterized by complete fecal incontinence and severe impairment of quality of life. The aim of this video is to serve as a tutorial for repair.
  
  
  METHODS
  A 27-year-old woman who developed a full-thickness recto-vaginal defect extended from the perineum to the upper third of the vagina has been managed through layered surgical repair without flaps.
  
  
  RESULTS
  Anatomy and fecal continence have been completely restored by a follow-up of 24 months.
  
  
  CONCLUSIONS
  The procedure described in this video has been shown to be effective and safe.
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy. federico.spelzini@gmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Spelzini
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Manodoro
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Verri
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Nicoli
authors.affiliation: Università Milano Bicocca, Azienda Ospedaliera San Gerardo, Via Pergolesi, 33-20900, Monza, MB, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Obstetric anal sphincter injury; Surgical repair; Traumatic cloaca