Introduction: In children, damage in the anal area which affects both the external anal sphincter and the internal anal sphincter is serious problem. Biofeedback is not effective if the external anal sphincter is severely damaged, and surgery by itself cannot effect a cure for incontinence in these cases.
Clinical case: a girl aged 6 yrs 8 months who from the age of two suffered from massive recurrent tricolephalosis, causing rectal prolapse, anal abscesses and fistulas, fistulectomy, and finally severe damage in the anal area with total incontinence. The treatment began with recto-anal manometry, and rectal sensitivity studies. Biofeedback was used before and after gracilis muscle transfer and colostomy. After 12 months, total continence was achieved, and has continued through 7 years of follow-up examinations.
Conclusions: To treat fecal incontinence combined with severe damage in the external anal sphincter, the following procedure should be followed: manometry and sensitivity studies, reconstruction of the external anal sphincter with gracilis muscle transfer, and biofeedback.