Colorectal trauma management remains variable worldwide. This study evaluated contemporary practice patterns using an anatomically stratified international survey. An anonymous, electronic survey assessing contemporary colorectal trauma management was distributed internationally through social media platforms and professional surgical societies to capture current practice patterns and variations in clinical decision-making. A total of 280 surgeons from 59 countries responded. For hemodynamically stable intraperitoneal colorectal injuries, 196/280 (70.00%) selected resection, when indicated, with primary repair or anastomosis, and routine colostomy was avoided by 227/280 (81.07%). Routine colostomy use differed by professional training (p = 0.018), with higher rates among general surgery residents (13/31, 41.94%) compared with attending trauma surgeons (17/107, 15.89%) and attending colorectal surgeons (5/42, 11.90%). Differences were also observed by hospital type (p = 0.037), with higher use in non-academic public general hospitals (10/35, 28.57%) and no routine use in Level II trauma centers (0/18, 0.00%). In hemodynamically unstable intraperitoneal colorectal injuries, colostomy was reported by 148/280 (52.86%). Colostomy reversal was most commonly scheduled between 3 and 6 months (146/280, 52.14%), without differences by training level or hospital type. Reported management of hemodynamically stable intraperitoneal colorectal injuries is predominantly colostomy-sparing, whereas reported approaches for unstable intraperitoneal injuries show mixed diversion practices. Differences by professional training and hospital type suggest persistent variability in contemporary colorectal trauma decision-making.
Keywords: Colon trauma; Colorectal injuries; Colostomy; Damage control surgery; Fecal diversion; International survey; Practice guidelines; Rectal trauma.
© 2026. The Author(s).