Purpose <p>This study aimed to evaluate the clinical outcomes of subtotal colectomy with ileorectal anastomosis (SCIRA) as an alternative treatment strategy for patients with pediatric intestinal pseudo-obstruction (PIPO) who experienced frequent enterostomy-related complications.</p> Methods <p>This retrospective observational study included PIPO patients who underwent SCIRA at our tertiary referral center between 2018 and 2023. Main outcomes were postoperative complications, surgical reinterventions, and the need for enterostomy replacement.</p> Results <p>Five patients underwent SCIRA, including four males and one female, at a median age of 14 years (range 6–20). Before SCIRA, all patients had an enterostomy and a history of multiple enterostomy-related complications, requiring a median of nine surgical reinterventions (range 2–13). After SCIRA, the median number of complications was 1 (range 0–2), and the median number of surgical reinterventions was 1 (range 0–2). None of the patients required replacement of their enterostomy. Median follow-up duration was 49 months (range 32–58).</p> Conclusion <p>Following SCIRA, a low number of complications and reinterventions was observed, indicating that SCIRA may be a viable option for PIPO patients with frequent enterostomy-related complications. This approach may help to reduce the need for multiple surgical procedures in this challenging patient population.</p>