Traumatic cloaca; surgical treatment of a disabling deformity

Traumatic cloaca is a disabling deformity of the anus and vagina caused by the severe damage of the sphincter apparatus and of the perineal body, resulting in a common aperture for the rectum and vagina, as in congenital cloaca. The most common cause is major obstetric injury occurred by median episiotomies that lead to third and fourth degree perineal lacerations, unrecognized or not repaired properly. The incidence is approximately 0.3% of all complicated vaginal deliveries. The resulting deformity is characterized by three-dimensional destruction of the perineal body, anterior disruption of the sphincter complex and loss of the distal rectovaginal septum of varying length. [1-4,7, 9] Other rare causes of traumatic cloaca may be severe injuries in women victims of sexual violence or by grave accidents in sports like cycling.