الفهرس 
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Abstract
The present study is concerned mainly about anal sphincter injury resulted from perineal traumas of different aetiologies. As Fecal incontinence is a distressing problem that has a negative impact on one’s quality of life and has social aspects, we aimed at reaching standardized and systematic lines of treatment to get the best results after perineal trauma and minimize the incidence of fecal incontinence.
Perineal injuries caused by blunt and penetrating traumas could result in significant morbidity or even mortality if not managed efficiently. These types of injury not only cause more destructive sphincter injury and thus worse treatment outcome , but also they are commonly accompanied by associated genitourinary , abdominal visceral and bony pelvic injuries .
The data obtained from the present study suggested that obstetric anal sphincter injury is the most frequent mode of trauma. Also, according to our results the primary repair of anal sphincter after obstetric injury using overlapping sphinctroplasty leads to a good satisfactory outcomes.
Anal sphincter injury can also be a result of an iatrogenic injury from an anal procedure, more commonly according to this study results is anal fistula surgery. In case of being diagnosed in the operative theatre, it could be managed the same as obstetric injury by primary repair using overlapping technique.
Blunt and penetrating traumas as a cause of sphincter injury are considered the most serious and destructive. Life threatening conditions should be addressed first especially if the injury is part of a polytrauma.
According to the results of the present study; there are many factors that influence the treatment outcomes regarding anal continence. These factors include the mode of trauma, type and site of injury and the operative procedure.
Regarding site of injury; total sphincter injury or multiple injuries at different sites are the worst types in the degree of post operative incontinence.
One of the common complications related to this particular anatomical region and type of trauma is wound complications. In the current study we had encountered wound complications in 40% of the studied cases. Most of them were infections and dehiscence of the skin and were treated by repeated wound dressing and use of local antiseptic and antimicrobial agents as well as repeated debridement of the devitalized tissues if needed. The use of preoperative prophylactic antibiotics and proper intraoperative management of the wound by sufficient debridement and proper wash and cleaning can reduce the incidence of wound compilications.
A plan of treatment is tailored to each case individually according to the assessment of the severity and extent of the perineal injury , whether the perineal wound and sphincter injury could be primary repaired or not , and if there is a need for fecal diversion or not .