الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 154 |  |  |
| | | from | 154 | | |
Abstract
Anal and rectal traumas are relatively rare, except as a result of iatrogenic damage, due to the anatomical position of the anorectum (protected by the pelvic bones, the sacrum and pelvic floor muscles). The anus is more frequently injured as it is more superficially located, but traumas involving the extraperitoneal rectum although more rare, are often more severe and extend to the neighbouring organs. The aim of surgery is to preserve life followed by controlling infections and in these cases, to preserve the patient’s fecal continence and evacuation function. Surgical options considering the specific controversy of diversion and exteriorization vs. primary closure in treating colonic injuries, it is clear that some patients may be closed primarily. Large bowel obstruction is much less frequent than small-bowel obstruction and its main cause in western countries is colorectal cancer. Large bowel obstruction is a serious condition that needs careful and prompt diagnostic and therapeutic measures to obviate harmful complications or even death (gangrene and perforation should be avoided). Recent technological innovations have changed therapeutic strategy, with a marked benefit for patient outcome (on-table lavage, colonic stents). There is now a trend towards single-stage procedures instead of a multistaged approach, the rational being to reduce the morbidity inherent to the latter. Multistaged procedures should remain, however, the preferable option for severely ill patients, with associated conditions, or in the face of bowel gangrene or faecal peritonitis. The preferred approach should be selected on an individual basis and tailored to the particular situation. Massive colonic bleeding is defined as bleeding that has become life threatening, usually requiring approximately five units of transfused blood. The site of the bleeding is difficult to pinpoint, because bleeding from the gastroduodenum and small bowel can present as bright red rectal bleeding. During the past 20 years, the diagnosis of massive colonic bleeding has changed remarkably. Colorectal perforation remains a disease of variable clinical manifestations and outcomes. The most common complications of inflammatory bowel disease (IBD) requiring emergency treatment are toxic colitis, perforation, toxic megacolon, bleeding, sepsis and intestinal obstruction. Furthermore, septic, hemorrhagic or perforative complications may be the first clinical manifestations of IBD. A transfer of these patients to specialized centres may be hazardous.