الفهرس 
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Abstract
Early diagnosis and aggressive treatment result in good prognosis and this is extremely important in lowering the mortality and morbidity from anorectal injuries.
Initially, all patients with traumatic injuries should be managed according to the Advanced Trauma Life Support (ATLS) principles defined by the American College of Surgeons. Trauma patients should be resuscitated and stabilised prior to examination of anoorectal injuries. Examination of the abdomen is essential in order to locate potential sites of penetration or bleeding. The presence of signs of peritonitis such as local or generalized guarding and rigidity will give an indication as to the severity of internal bowel and/or organ damage. Additionally, digital rectal examination (DRE) of the anus/rectum allows for assessment of anal sphincter tone, detection of rectal foreign bodies, gastrointestinal bleeding and potential pelvic fractures. If a rectal injury is suspected, a rigid proctoscopy or sigmoidoscopy is advised.
Due to the site of the anorectum and the high contamination with stool, infection of the wounds is very dangerous and may affect the healing, repair, and prognosis and should be taken seriously , so if massive destruction, severe infection, or patients with high risk for infection due to delayed management, peritonitis , immunocompromized patients, fecal diversion is preferred . Antibiotics should be mandatory as a prophylaxis in all cases with wound contamination.
Laparoscopy in selected cases better to be done to exclude intraperitoneal rectal injury and preferred than laparotomy.
The most important factors in determining treatment for anorectal injuries are these: (i) the general physical condition of the patient, (ii) the mechanism by which the injury was incurred, (iii) the interval between the injury and operative intervention, (iv) the presence of shock or hemodynamic instability, (v) the presence of peritoneal contamination, (vi) any injury or avulsion of the mesentery of the rectum, and (vii) the presence of multiple organ injury (viii) the site of the injury (ix) the degree and grade of injury (x) sphincter affection.
Based on our review, we recommend primary repair with diverting colostomy in patients with destructive injuries involving the anus and rectum.
Patients with an isolated intraperitoneal rectal injury or injury to the anus without significant soft tissue loss or sphincter destruction may be managed without a colostomy.
There are no definitive guidelines on the management of trauma to the rectum and anus. Management should be individually assessed and managed in a separable maneuver with patient variation.
Diversion better to be done with proximal loop colostomy or end colostomy than presacral drainage as presacral drainage is more hazardous and with no important role in infection.
We recommend further studies with large numbers are necessary to identify modifiable factors to improve morbidity after traumatic anorectal injuries.
Raising campaigns to educate people about accidents and their catastrophes is essential as prevention is better than cure.