[War injuries of the rectum and perineum]

The treatment results of 35 wounded with rectal and perineal lesion, treated in the period from 1991 to 1993 were analyzed retrospectively. In military hospitals, 82% of wounded were primarily surgically managed. The majority (65.8%) was with injury of intraperitoneal rectal segment, 10 patients (28.5%) were with the lesion of extraperitoneal segment and 2 patients (5.7%) were with the injury of anal tract and perineum. The injuries were mostly inflected by the bullets of various calibers (42.6%). Multiple or combined injuries were found in 91.6% of wounded with rectal injury and 38.2% of them were managed within 6 hours after injury. Different surgical procedures, most frequently the lesion suture and proximal colostomy (n = 14) were primarily used. Postoperative complications occurred in 10 wounded (28.6%). In 3 wounded it was reintervened by Hartmann's procedure. Mortality rate was 8.5% (n = 3). Anorectal war injuries are the most severe of all the colonic injuries. To our experience and the unique war surgical doctrine in the primary treatment of rectum injury, the most important is to perform terminal colostomy, injury suture (always intraperitoneal, and extraperitoneal if possible, including the sphincter muscles approximation) and presacral drainage.