Background
The anal sphincter is anatomically well protected by the fat tissue in the ischiorectal fossa and by the gluteal muscles and pelvic structures [1]. The injuries are thus not frequent, and are mostly caused iatrogenically (surgery, childbirth), or by sexual injuries, or war injuries from bullets, fragments, etc [2-4]. The commonest cause of anal sphincter damage is child birth injury and the site is always the anterior midline and easily treated as the external anal sphincter muscles are mainly shifted laterally [4]. Complete division of the sphincter ring is followed by retraction of the cut ends to about half a circle and, during the subsequent healing the gap is filled by fibrous tissue which only contracts a little and leaves a long non-contractile segment. Clinical assessment of traumatic anal injury may suffice in determining the sphincter defect in resource-limited settings where endoanal ultrasonograpy is not available [5, 6]. The aim of surgical repair is to remove this segment and recreate a long anal canal surrounded by active sphincter muscle [5]. Traumatic perineal injuries resulting in anal sphincter disruption often occur with severe associated life-threatening injuries. Once stabilized, assessment during the secondary survey will identify perineal and/ or anal injuries. The general principles of injury prioritization, perineal debridement and diversion of the faecal stream in cases of associated rectal laceration are important [2, 3].