Emergencies

Abstract

12.1

Accidental anorectal trauma are infrequent but iatrogenic injury to the anus and rectum are relatively frequent. The etiology includes closed trauma, childbirth, ingested foreign bodies, foreign bodies introduced per anum, rectal impalement, sexual assault, jatrogenic diagnostic or therapeutic procedures, and penetrating injuries (stab or gunshot wounds).

The diagnosis must be prompt and accurate, leading to appropriate and tempestive management accoding to the algorithm described. The main principles of ano-rectal injury management are described, including treatment of foreing bodies retained into the rectum.Finally, the possible functional sequaele of these injuries are discussed.

12.2

Large Bowel Obstruction: Aetiology; symptoms; diagnosis; general management. Special conditions: Neoplastic colorectal obstruction (including current treatment recommendations) Colonic volvulus (including current treatment recommendations)

12.3

Lower gastrointestinal bleeding (LGIB) is defined as any hemorrhage occurring distal to the ligament of Treitz and may present as acute or chronic. Acute LGIB is defined as bleeding of less than 3 days duration that results in haemodynamic compromise, anaemia or the need for blood transfusion. Chronic LGIB is defined as any bleeding of more than 3 days duration and includes occult and obscure LGIB. In most cases LGIB is a minor, self-limiting event with relatively low mortality ranging from 2% to 4%. Severe, life-threatening haemorrhage is rare. The vast majority of LGIBs are of colonic origin. Diverticular disease is the most likely cause of LGIB in adults and accounts for as many as 40% of all LGIBs. Other causes of LGIBs are arteriovenous malformations (angiodysplasia), inflammatory bowel disease (IBD), neoplasms, ischaemic colitis, anorectal disease, colonic varices and other less frequent causes. Accurate diagnosis of the cause and location of acute bleeding is challenging.The course of evaluation is determined by the extent and severity of the haemorrhage. Once the diagnosis of severe LGIB is established, resuscitative measures should be initiated. Diagnostic procedures should be started depending and according to the patient’s condition.

Oesophagogastroduodenoscopy, digital rectal examination, proctoscopy, colonoscopy, angiography, nuclear scintigraphy, CT, MRI and video capsule are diagnostic modalities. Definite treatment is started as soon as the diagnosis is established and the bleeding site identified. Approximately 80% of acute severe LGIBs stop spontaneously. Surgical treatment is inevitable in 10–25% of cases.