Overlapping sphincteroplasty and modified lotus petal flap for delayed repair of traumatic cloaca

Traumatic cloaca is a disabling condition characterized by disruption of the perineal body, anterior sphincter tears and loss of the distal rectovaginal septum. Anterior overlapping sphincteroplasty is the method of choice to treat faecal incontinence caused by obstetric injury. However, reconstruction of large perineal body defects may be a challenging task for surgeons. Herein we describe the successful use of a modified lotus petal flap following overlapping sphincteroplasty to repair a traumatic cloaca that had occurred during vaginal delivery 20 years earlier. After 3 months of follow-up and ileostomy closure, the patient had a good aesthetic result and only minor faecal incontinence episodes not requiring pads, fully recovered urinary continence and a significant improvement in her quality of life.