AbstractTen patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo‐anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow‐up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n = 7) the follow‐up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life‐threatening, haemorrhagic chronic irradiation injury to the