Most severe colonic trauma results from surgical or endoscopic interventions, accidents, and penetrating wounds. More than 95% of colonic injuries are penetrating (190) due to gunshot and stab wounds, iatrogenic injuries, automobile accidents, war wounds, and miscellaneous sexual injuries, in decreasing order of incidence. Trauma may also result from the insertion of enema tubes. The extent of the damage varies with the cause. The pathologic spectrum ranges from hematomas to full-thickness lacerations that, if not repaired, lead to perforation and peritonitis. Intramural hematomas complicate blunt abdominal trauma and bleeding diatheses, such as hemophilia. Blunt abdominal trauma in child abuse syndromes associates with significant morbidity and mortality. The midabdomen is particularly vulnerable to the direct blows and results in compression injuries to anatomically fixed viscera against the spine (191). Colonic trauma accounts for only 3% to 5% of blunt abdominal injuries (192) and most affect the descending colon, ascending colon, or cecum (192,193). The clinical features depend on the size of the hematoma and can include acute or chronic pain, obstruction, rectal bleeding, anemia, and hemoperitoneum (194,195).