Neonatal Perineal Tear: A Rare Birth Injury

A (2.8 kg) 2-day-old female baby was brought to the hospital after delivery conducted by the local traditional healers. The baby was in sepsis with a perineal tear extending from the vagina/vestibule to the rectum running deep to the perineum about 2cms with devitalised tissues of peri-anal margin and vulva (Fig. 1). On careful evaluation of the history, delivery was assisted by pulling out the baby with thumb in anus and fingers around the buttock (evident by the presence of abrasions, cellulitis and maceration of the skin in the buttock) and vulva resulting in the injury. The blood culture and wound swab showed growth of E coli. The baby was put on cefotaxime, amikacin and metronidazole. Thorough wound irrigation with debridement of devitalised tissues was done. The rectal mucosa and vaginal mucosa were repaired with interrupted vicryl 5–0. The perineal body and muscles were repaired with vicryl 4–0, and perineal skin with vicryl 5–0. Loop sigmoid colostomy and on table distal stoma saline wash was done to clear the meconium from the rectum. Colostomy was closed after 6 weeks after the adequate anal dilatation was achieved. At 12 months follow up, the stool frequency is 1 – 2 per day and continent. Figure 1: Contaminated perineal wound with gangrenous vulval margins, devitalised and gangrenous peri-anal tissue with surrounding cellulitis. Insets show repaired and healed lesions.