Anal trauma is relatively rare, while injuries to the rectum and perineum are more common both in peacetime and wartime.

bubble_chart Etiology

1. Anal Puncture Wounds Hard foreign objects such as metal, wood chips, or bamboo tips can puncture the anus and soft tissues of the buttocks when a person falls from a height and lands on their buttocks, mostly as accidental injuries. However, during the Vietnam War against the U.S., the Vietnamese people set up bamboo spike traps, often causing American soldiers to fall into them and sustain injuries. In rural areas, injuries from bull horns are common; when an aggressive water buffalo becomes enraged and chases a fleeing person from behind, it may gore the buttocks with its horns, frequently resulting in puncture wounds to the anus and buttocks soft tissues, as well as anal lacerations.

2. Firearm Wounds During wartime, shrapnel or bullets hitting the anal area are relatively rare among combat injuries. In our military's self-defense counterattack against Vietnam (1979), rectal and anal injuries accounted for only 3.64%.

3. Contusion and Laceration Injuries These are often seen in individuals with mental disorders or sexual deviancy who insert foreign objects into the anus or rectum, causing injury. Iatrogenic injuries can also occur, such as during proctoscopy or sigmoidoscopy when the patient clenches their anus in fear and the examiner applies excessive force. Additionally, forgetting to remove a rectal thermometer, leading to breakage and anal cuts, usually results in minor injuries. However, improper surgical procedures, such as those for anal fistulas, can lead to more severe complications like fecal incontinence. {|102|}

Classification {|###|}1. Contusion (hematoma) {|###|}2. Laceration {|###|}⑴ Non-perforating (non-metallic); {|###|}⑵ Perforating (full-thickness, but not completely transected); {|###|}⑶ Massive destruction (avulsion, complex, rupture, tissue loss). {|###|}Post-injury symptoms include anal pain, bleeding, or fecal incontinence, as well as difficulty in defecation or narrow stools due to stenosis. Early post-injury examination may reveal lacerations and bleeding in the anal region and surrounding tissues. In cases where the anal sphincter is transected, fecal leakage and contamination are often observed. In prolonged cases, severe local infection may occur, manifesting as deep cellulitis of the gluteus maximus.

bubble_chart Diagnosis

1. Medical History Whether it is a war injury or a peacetime trauma, a history of trauma to the anal region is the primary method for obtaining a definitive diagnosis.

2. Clinical Manifestations Post-injury symptoms include pain in the anal region, bleeding, or fecal incontinence, as well as stenosis leading to difficulty in defecation and thin stools. Early post-injury examination may reveal lacerations and bleeding in the anal region and surrounding tissues. In cases of transection of the anal sphincter, fecal leakage and contamination are common. In cases of prolonged duration, severe local infection may be present, with visible deep cellulitis in the gluteus maximus.

3. Digital Rectal Examination Under strict aseptic technique, perform a digital rectal examination using a gloved finger. The insertion of the finger into the anus should be gentle. Instruct the patient to contract the anus to assess for anal sphincter rupture. If rupture is present, the anus will lose tension and become lax. If only partial tearing occurs, some sphincter tension can still be felt. The digital examination can also determine whether there is a perforation in the lower rectum, as judged by the examiner's sensation. A smooth intestinal wall indicates no injury, whereas a perforation will cause localized pain and a sense of emptiness.

1. Anal injury During local debridement, tissue should be preserved as much as possible. After alignment, suture and repair should be performed to prevent malunion. Except for a single rupture, the anal sphincter should be sutured and not excised. After local debridement, a transverse double-layer suture should be performed, and a cigarette drain should be placed anterior to the sacrum around the anal canal.

2. Proximal colostomy To prevent local infection after anal and anal canal repair, a sigmoid colostomy should be performed proximally. This allows the repaired area to rest adequately and heal smoothly. The distal sigmoid colon and rectum should be thoroughly irrigated with normal saline and cleaned with neomycin and metronidazole solution.

3. Infection prevention and control Third-generation cephalosporins such as cefoperazone or ceftriaxone and metronidazole should be used systemically before, during, and after surgery to prevent and control infection.