A diffuse cavernous hemangioma of the colon and rectum was made in a 20-year-old man. Treatment consisted of total colectomy with ileorectostomy. A proctectomy was mandatory four years later because of massive rectal bleeding. A sphincter-saving operation was possible and bowel continuity was restored with an ileal "J" pouch-anal anastomosis. Cavernous hemangioma generally affects the rectosigmoid and colo-anal sleeve anastomosis is the treatment of choice. When cavernous hemangioma affects the colon and rectum or when the colon has been removed for an other reason, an ileo-anal anastomosis, although technically difficult, can be performed in order to prevent recurrent bleeding while preserving continence and allowing acceptable bowel function.