RESUMEN
This study aims to analyze our experience in the management of anorectal injuries with a particular reference to the use of rectal wall repair, diverting colostomy, distal rectal washout andpresacral drainage. The management of 26 patients with anorectal injuries treated at Riyadh Central Hospital, over an 8 year period [1997-2004] was reviewed. There were 15 patients with extraperitoneal injuries. Transrectal repair was possible in 12 patients, diverting colostomy was carried out in 7 patients, distal washout in 4, and none had formal presacral drainage. There were 8 patients with intraperitoneal injury. All were repaired through laparotomy, only 4 patients had diverting colostomy None were treated by either distal washout or presacral drainage. Three patients had an anal sphincter injury treated by sphincter repair and diverting colostomy and perineal drainage. There -was no mortality related to anorectal injuries in our study. We conclude that most anorectal injuries in our civilian practice are due to low velocity firearm injury or non firearm injury which produced less devastating injuries. Intraperitoneal rectal injury can be managed by rectal wall repair and that diverting loop colostomy should be performed only if there is gross peritoneal contamination. Extraperitoneal injury can be repaired if accessible, colostomy is indicated for high grade injury and if rectal wall repair is not possible. Most civilian rectal injuries can be managed without routine use of distal rectal washout and presacral drainage