Successful non-operative management of wound dehiscence after PSARP: case report

Background Wound dehiscence is a common early postoperative complication following Posterior Sagittal Anorectoplasty (PSARP) for Anorectal malformation (ARM). Conservative wound management is an effective strategy to promote healing while preserving neoanus function after postoperative complications. We present a case of wound dehiscence following PSARP for ARM, treated conservatively with an excellent outcome and preservation of neoanus function. Case presentation We present a preterm female neonate with a rectoperineal fistula and cardiac anomalies who underwent PSARP at four months of age. The patient developed wound dehiscence with a 5-mm gap at perineal body and foul-smelling discharge on the fifth postoperative day. Conservative management was implemented with consistent dressings containing Silvercel and a hemoglobin-based spray. This was done because the parents refused surgical intervention in the form of stoma creation. This approach resulted in substantial wound improvement and preservation of the neoanus and sphincter function. Conclusion This case suggests that conservative, multidisciplinary management may be a feasible option for selected cases of superficial wound dehiscence after PSARP when the neoanus is intact and the patient is clinically stable. Topical purified hemoglobin spray with advanced dressings was associated with progressive wound healing and preserved neoanal function. Further pediatric studies are needed to confirm its safety and effectiveness for post-PSARP wound complications.