In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war.

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.

Diffuse idiopathic varices in the colon characterized by lower gastrointestinal bleedingColon varices are very rare lesions that usually present as secondary to portal hypertension. Idiopathic colon varices are even rarer, and should be considered especially in the etiology of massive lower gastrointestinal bleeding. Forty-five year old male presented to our hospital with complaints of recurrent rectal bleeding for one week and severe anemia. The patient was transfused with 4 units of blood. His colonoscopy revealed diffuse submucosal varices. The tests performed for investigation of etiology did not reveal any portal pathology. The patient did not experience another episode of active bleeding during follow-up and was discharged with conservative recommendations. Idiopathic colon varices are rare but should be considered in the differential diagnosis of patients presenting with massive rectal bleeding. Conservative approach is first line of treatment, reserving segmental or total colectomy only for ongoing hemorrhage.