الفهرس 
Anatomy of the Pelvic Floor, Rectum and Anal CanalOnly 14 pages are availabe for public view
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Abstract
One of the earliest descriptions of bowl trauma came from the Byzantine Empire (324-1453A.D). The historical writer Philostorgius (fifth century) described the fatal wounding of Emperor Julian the Apostate (361-363 A.D) when he wrote, ”a cavalryman severely wounded the emperor in the abdomen with his spear and injured the peritoneum and intestines: when the point of the weapon was pulled out, there followed an outflow of feces mixed with blood.”
Anorectal injuries are relatively rare (1/1600 surgical operations) and delay in the diagnosis and management of a bowel injury can result in significant morbidity and mortality to the patient.
The anatomy of the pelvic floor, rectum and anal canal is a complex surprisingly dynamic field with new insights, discoveries and controversies.
The causes of anorectal injures are numerous including iatrogenic causes as haemorroidctomy ,fistulctomy,fissurectomy and also during normal delivery .Blunt trauma is an infrequent cause of rectal injury (5-10%). The cause of this type of injury is usually motor vehicle, motorcycle or pedestrian-vehicular accidents. Foreign body is afrequent cause through the anal passage (generally for sexual purposes), followed by oral ingestion and migration from neighboring organs.
therapeutic injuries are reported as Perforation by Therapeutic Enema, Injury from Barium Enema, Endoscopically Induced Trauma, Rectal thermometers are well-known causes of perforation during the first few days of a newborn’s life, Irradiation-Induced Proctitis, Intraoperative injury to the colon and rectum can occur during any procedure pelvis or abdomen because the colorectum extends into every quadrant. also can cause anorectal injury. Sexual assault perineum, child abuse
Delay in the diagnosis and management of a bowel injury can result in significant morbidity and mortality to the patient and can lead to medicolegal pitfalls.
Manegment of anorectal injures depend on type and mechanism of injury so we had variable techniqes in treatment.some injures caused by sexual assult or self inflicted usally diagnosed late due to histinsy of the patient to call medical help and this delaying is the cause of complication.
The principles of management for anorectal injuries were developed on the fields of military conflict, later on this will applied in civilian practice
During the secondary survey the colorectal injuries are identified, leading to the final phase, definitive care. Without the secondary survey, more subtle perineal and rectal wounds may be overlooked, and delay in diagnosis and late treatment lead to increased morbidity and mortality
The most important factors in determining treatment for penetrating 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
The components of management, developed from lessons learned from combat experiences, have remained controversial and include ”4 Ds dictum” (1) diversion of fecal stream, (2) distal rectal washout (DRWO), (3) presacral drainage (PSD), and (4) debridement and closure of wounds when possible.
Extensive destruction of the rectum that requires a resection may best be served with a Hartmann’s procedure, whereas injuries that are not repaired or require limited dissection may be addressed by loop colostomy.
Recently, there have been reports of primary repair without fecal diversion in selected extraperitoneal rectal injuries
Though extremely rare, abdomenoperineal resection has been described for patients with severe bleeding, massive tissue loss, or devascularizing injuries. Recent reports have introduced laparoscopy in the management of rectal injuries.
Patients with significant associated pelvic injuries, a pelvic strap belt is a good way of providing temporary hemodynamic stabilization. External fixation like pelvic clamp for unstable pelvic fracture takes precedence over the repair of anal lesions, thus minimizing blood loss without laparotomy yielded excellent results.
Several disabling conditions can follow anorectal trauma, the most frequent being faecal incontinence. But also defecation problems can arise as a consequence of strictures or rectal denervation.
Sexual assaults, particularly in childhood, usually leave profound psychological problems and, frequently, tenesmus or pelvic dyssynergia causing obstructed defecation.