Abstract
It is now accepted that intraperitoneal rectal injuries should be treated as abdominal colonic injuries. Therefore, this is discussed in the chapter on colonic injuries. We will focus on extraperitoneal rectal injuries. Associated lesions are common and should always be searched for based on the trauma mechanism. Historically, rectal injuries were managed with the “4 D’s”: diversion, pre-sacral drainage, direct repair, and distal washout. Damage control surgery for hemorrhage and contamination is the first priority with staged procedures for reconstruction after patient stabilization.