Primary Reconstruction of Combined Anorectal and Vaginal Blast Injury in a Pediatric Patient without Fecal Diversion:...

Blast injuries involving the perineum are rare, particularly in the pediatric population, and may result in complex combined anorectal and genitourinary trauma. These injuries present major reconstructive challenges because of contamination risk, infection, and possible long-term functional impairment. Management has traditionally favored staged procedures with fecal diversion, especially in severe anorectal and rectovaginal injuries. We report here the case of a 10-year-old girl who sustained a severe blast injury resulting in a large perineal defect involving the anal canal, perineal body, and posterior vaginal wall. The patient underwent a successful single-stage reconstruction surgery consisting of posterior vaginal wall repair, perineal body reconstruction, and anterior anorectal wall repair without diverting colostomy. She tolerated the procedure well and remained hemodynamically stable throughout the perioperative course. At 8-week follow-up, the reconstructed tissues had completely healed, with preserved fecal continence and no pain, although residual scarring from the initial injury was noted. This case adds to the limited pediatric literature on severe perineal trauma and suggests that, in select hemodynamically stable patients with extraperitoneal injury and viable tissues, primary layered reconstruction without fecal diversion may be feasible.