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This prospective, randomized, controlled study was undertaken to compare primary repair or anastomosis with intracolonic bypassvs.ostomy in severe colon and intraperitoneal rectal injury. Patients were randomized at surgery following confirmation of injury. Data collected included demographics, mechanism and location of injury, trauma score (TS), injury severity score (ISS), penetrating abdominal trauma index (PATI), complications, length of hospital stay, and hospital charges. Twenty-two patients were studied: 11 with intracolonic bypass and 11 controls. The experimental and control groups were statistically similar in demographics and mechanism of injury, severity of injury (TS=13.8vs.12.8; ISS=27.5vs.24.2; PATI=40.5vs.35.0), and complication rate. Length of stay (12.2 daysvs.20.7 days) and charges $27,885vs.$53,599) tended to be greater in controls, and the comparison did not include subsequent colostomy closure. This study supports intracolonic bypass as a safe alternative to ostomy in severe colon and intraperitoneal rectal trauma.