Total Colectomy in Severe Crohn's Colitis in Children: is Permanent Ileostomy Necessary?

•Currently, IRA is offered in a minority of adult referral centers in selective patients with no perianal or small intestinal involvement. Considering the lifelong duration of the disease, the pediatric population would arguably benefit significantly from this approach but the amount of literature in the pediatric population is very limited.•Ileorectal anastomosis (IRA) after colectomy should be considered for medically refractory isolated Crohn's colitis in selected patients.•A larger prospective study is necessary to identify patient eligibility timing of IRA, and post-operative surveillance strategy before recommendation of IRA as a standard treatment.