Anorectum and perineal injuries are clinical conditions with very high morbidity and mortality due to possible additional injuries to the neighboring structures, especially in extraordinary conditions such as war and terror. Morbidity and mortality rate differences of traumas in civil and war situations; The high destructive power and speed of conventional weapons (mines, hand-bombs, or bullet-proof bullets, shrapnel pieces with high destructive power); The amount of contamination that may occur due to field conditions, the time between injury and definitive treatment, and the possible late use of additional medical treatment. Firearm injuries are the most common cause of non-iatrogenic anorectal injury. Examination of the patient with anorectal trauma should be performed initially a rectal exam, and the Foley catheter. If necessary and if there is no contraindication, sigmoidoscopy should be performed. Most patients can undergo a radiological examination. Since barium graphs are contraindicated, rectum can be examined with graphs made with water-soluble contrasting substances. If sigmoidoscopy can not be performed due to technical difficulties, extraperitoneal injuries can be detected by performing triple contrast (IV, PO, R) CT. The vasculature of the patient is opened, the urinary tract is catheterized, wide spectrum antibiotherapy is initiated and tetanus prophylaxis is performed. Fecal contamination of pelvic tissue may lead to the development of serious infections, which can be fatal. The approach we can shorten with “4D” in classical treatment is available. These include diversion, drainage / debridement, direct repair, and distal washout. Complications can be summarized as colostomy, sepsis, osteomyelitis, bladder and complex anorectal fistula, pelvic hematoma, rectal incontinence and stricture, urinary incontinence, loss of sexual function, perineal and scrotum-penis necrosis and synergistic gangrene, pelvic abscess related bacteriemia and multiple organ failure. It is very important to refer them to the specialized Harp Surgery centers for definitive therapies after the initial treatment.

Keywords: morbidity, perianal injuries, war surgery