Cases in which the perineum is apparently intact, but in which the sphincter is not united (Figs. 35, 36).
These are the cases in which a complete laceration of the perineum is apparently completely healed after operation, but the patient finds that she has incontinence both of flatus and fæces.
On inspection of Fig. 35 this will be well explained. The patient is lying on her back in the lithotomy position: a represents the sphincter which has been torn through; the two cut ends, b and c, are represented by two dark circular, somewhat depressed spots. The rectal orifice gapes; there is no sphincteric power present. The perineum anterior to the anus is firmly healed.
Operation. The most certain and effectual method in these cases is to split up the healed perineum antero-posteriorly and treat the case as one of complete laceration of the perineum (see [p. 128]). This has been carried out in the case represented in the illustration (Fig. 35), and Fig. 36 shows the result: the patient entirely recovered power over the sphincter ani and the sustaining power of the pelvic floor was much improved.
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Fig. 35. Repair of a Lacerated Perineum, with Non-union of the Sphincter
Ani, before a Plastic Operation. (From a photograph.)
a. Ununited sphincter ani. b, c. Buried ends of torn sphincter. |
Fig. 36. Repair of a Laceration of the Perineum after a Plastic Operation. (From a photograph.)
a. Repaired sphincter ani. b. Anus. s. Resutured perineum. |
CHAPTER XIII
OPERATIONS UPON THE URETHRA AND BLADDER
EXTIRPATION OF A URETHRAL CARUNCLE
Indications. A urethral caruncle is a bright red, tender tumour, usually on the posterior portion of the urethral orifice.