Six cases of functional megacolon in psychotic patients have been treated by subtotal colectomy and ileoproctostomy without mortality and have been followed from 1 to 6 years. Although “colonization” of the ileum has occurred with rather marked dilatation of the distal ileum in most cases, transit time of the gastrointestinal tract has remained essentially normal. Lasting clinical improvement seems to have been achieved. No significant diarrhea has developed, no nutritional disturbances have appeared, and no further hospitalization for obstipation has been necessary. The use of subtotal colectomy in the management of these cases is recommended.