The management of colon and rectal injuries has evolved significantly over the last four decades. Today, primary repair or resection with anastomosis is the optimal strategy for most patients with colonic injuries. Diverting or protective ostomy still has a role in select high-risk injuries. In the management of accessible rectal injuries, there is an increasing role for primary repair or anastomosis. Diversion alone without direct repair is sufficient to treat isolated extraperitoneal rectal injuries. The use of presacral drainage and distal washout are no longer routinely recommended. A colostomy is usually indicated in the management of complex perineal wounds and should be performed as early as possible.