Crohn’s disease presents with variable degree of intestinal involvement. There are patients who have disease limited to the large intestine and are not responsive to medical management. Those patients could be candidate for intentional ileal pouch-anal anastomosis. This series demonstrates the feasibility of ileal pouch-anal anastomosis for these rare, selected patients. This subgroup was compared with patients with incidental pathologic Crohn’s disease after ileal pouch performed with a preoperative diagnosis of ulcerative colitis and with those who developed delayed signs of Crohn’s disease after ileal pouch-anal anastomosis for ulcerative colitis.