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Case report
Surgical repair of an obstetric cloaca with review of the literature
  1. Alan Paul Gehrich1,
  2. Edward McClellan2 and
  3. Suzanne Gillern3
  1. 1OB/GYN, Tripler Army Medical Center, Honolulu, Hawaii, USA
  2. 2OB/GYN, Evans Army Community Hospital, Ft Carson, Colorado, USA
  3. 3Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Alan Paul Gehrich;{at}


A complete perineal wound breakdown of a fourth degree laceration leading to a cloaca is a rare but devastating complication of vaginal childbirth. A 32-year-old primiparous woman presented with an obstetric cloaca 4 months following delivery. She underwent preoperative evaluation and, following extensive counselling, elected to proceed with operative repair. The procedure is presented in 15 well-defined steps with photos. The repair was performed in standard fashion with three supplementary steps. These included: (1) division of the rectovaginal tissue into three distinct layers; (2) attachment of these layers individually to the reconstructed perineal body and sphincter and (3) incorporation of the levator muscles into the repair. The wound healed well within 6 weeks of repair. Now 3½ years postoperatively, the patient has no faecal incontinence or sexual dysfunction and only minimal defecatory dysfunction. The discussion describes our surgical approach in the context of a review of the literature.

  • pregnancy
  • incontinence
  • gastrointestinal surgery

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  • Contributors AG, with the assistance of EMcC, performed surgery, took and edited all photos, and wrote the manuscript. SG provided expert advice on the preoperative evaluation and surgical procedure.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.