BACKGROUND Patients suffering from severe ulcerative colitis often receive emergency colectomy at vital indication. Some of them are offered an ileal pouch-anal anastomosis a few months later. METHODS All patients (n = 80) from May 1985 to August 1998 who were subjected to emergency colectomy at the National Hospital of Norway because of severe ulcerative colitis were studied prospectively. 40 patients later underwent a successful ileal pouch-anal anastomosis operation; 36 of them were sent a questionnaire assessing anal function. RESULTS No patients died during admission or within 30 days of emergency colectomy. Five patients (6%) developed postoperative complications requiring reoperation. 31 patients returned the questionnaire. All reported full bowel control, although two used pads during night. Mean number of evacuations per 24 hours was six. 14 patients (45%) usually had evacuations during night. All patients would prefer ileal pouch-anal anastomosis if they were given the choice between this and permanent ileostomy again. 87% were satisfied with the operation result, 10% were moderately satisfied, 3% were not satisfied. CONCLUSIONS The results of urgent colectomy are good, and patients aged < 50 may expect good anal function after receiving ileal pouch-anal anastomosis.