The indications for total colectomy in the pediatric population include total colonic Hirschsprungs disease, ulcerative colitis, and familial adenomatous polyposis. Children with ulcerative colitis may require total colectomy because of disease refractory to medical management, growth arrest secondary to the disease itself, or to allow cessation of drug therapy that has adverse effects. Surgical options include total colectomy with end ileostomy, and total proctocolectomy with ileoanal anastomosis. An ileal J pouch may be used as a fecal reservoir. A diverting loop ileostomy can protect the pouch for optimal healing during recovery.