Local debridement, drainage, and diverting colostomy, with or without primary repair of the rectum, have been considered to be the standard treatment for most rectal injuries, but they are not sufficient for those patients sustaining uncontrollable bleeding or extensive rectal devascularization. This report assessed the indications and results of abdominoperineal resection of the rectum in these patients. Ten patients who were victims of explosive trauma presented with massive perineal injuries and extensive rectal devascularization. Six of these were treated with local debridement of necrotic tissue, pararectal drainage, antibiotics, and colostomy. Five of the six patients initially treated by colostomy died after operation from hemorrhage or sepsis. The sixth patients, who survived, had an abdominal resection of the rectum performed 5 days after the colostomy for removal of a gangrenous rectum. All five of those who underwent abdominoperineal resection survived (p less than 0.01). Increasing violence in the life patterns of modern society enhances the possibility of occurrence of this type of lesion, previously limited to military practice. The need for careful investigation of rectal viability is emphasized. Primary abdominoperineal resection of the rectum is advised when extensive devascularization has occurred.