Traumatic rectal lesions can be seen in both blunt and penetrating traumas and are associated with a high morbidity and high mortality. This is a review of the literature on diagnosis and treatment of intra- and extraperitoneal rectal lesions. There is a consensus, that intraperitoneal rectal lesions should be treated with primary repair alone. There is more debate concerning the extraperitoneal lesions, and the level of evidence is generally low. We suggest, that extraperitoneal rectal lesions should be treated with colostomy.