Abstract The cases of thirty-six patients undergoing ileorectal anastomosis for inflammatory disease of the colon have been reviewed. No anastomosis using healthy bowel failed, and all these patients did well clinically. Pathologic involvement of the anastomosed bowel leaves the patient liable to failure of the anastomosis, but does not mean that the anastomosis is doomed. One half of the patients with Crohn's disease did not tolerate ileorectal anastomosis. The results of ileoproctostomy performed for chronic ulcerative colitis were much better than those achieved in Crohn's disease. The incidence of failure or postoperative death is significant. Reconstitution of bowel continuity in an ileostomy patients is an exciting possibility, but the risks associated with this operating must be considered carefully before undertaking ileoproctostomy.