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What is a Conventional Ileostomy?

In some people, due to disease, damage, or other reasons, the large intestine and rectum have been removed. In a conventional ileostomy, about an inch of the small intestine is brought out through the skin of the abdomen and formed into an opening called a stoma. A plastic bag is connected to the skin around the stoma in order to catch the output of the small intestine.

What is a Kock Pouch?

The Kock Pouch is an example of a continent ileostomy, so called because the contents of the small intestine stay within the body until the patient decides to empty it. The Kock pouch consists of a reservoir constructed from the small intestine, and a nipple valve which keeps the contents of the reservoir inside the body, and permits entry of an external catheter to drain the pouch when desired.

The catheter is a simple hollow plastic tube. It is inserted about 5 inches into the stoma, and the contents of the reservoir come out on their own. Immediately after surgery the pouch is emptied about every three hours, because the reservoir is small. But following the surgery it grows in size until it can be emptied only 3 or 4 times a day, approximately 2 months after surgery. In the absence of late night meals, it is rare to have to get up at night to empty. This is in contrast to some of the alternative surgeries such as the J pouch, where night time emptyings are generally necessary. In between emptyings, the stoma is covered with a piece of gauze to absorb the mucus coming from it. The stoma is typically about 1/2 inch in diameter.

Kock pouches are not used to replace colostomies.

A rough drawing showing different parts of the Kock pouch:

Another drawing of the Kock pouch, rotated 90 degrees from the above one:

Complications

One possible problem with the Kock pouch can occur when the nipple valve slips. This can result in difficulties inserting the tube, and eventually, incontinence. This happened more frequently in the past when the staples holding the valve came undone. But this problem is much less frequent now that stronger staples are used.

Another complication is pouchitis, an inflammation of the mucous membrane of the pouch. Symptoms include loose stools and sometimes bleeding. Pouchitis is treated with antibiotics, and the symptoms usually disappear within a week.

Kock Pouch Surgeons

Here is a list of surgeons who have experience doing Kock pouch surgery. If you know of others who should be added to the list, please contact me at pls@alumni.caltech.edu.


Dr. Robert H. Barlett 	(734) 936-5822		Ann Arbor, MI
Dr. Joel J. Bauer	(212) 517-8600		New York, NY
Dr. Zane Cohen		(416) 586-8346		Toronto, Ontario
Dr. Victor Fazio	(216) 444-6672		Cleveland, OH
Dr. Robert B. Gilsdorf	(602) 254-5146		Phoenix, AZ
Dr. Stephen Gorfine (212) 517-8600		New York, NY
Dr. Michael Harris	(212) 241-1763		New York, NY
Dr. Robert Jacobson	(214) 824-1730		Dallas, TX
Dr. Jonathon Worsey	(858) 558-2272		San Diego, CA
Dr. Rolando Rolandelli (973) 971-7200	Morristown, NJ
Dr. David Sung		(310) 395-6123		Santa Monica, CA

Also see this link.
Last updated 7/19/11

A picture of a Kock pouch stoma (little red spot just above the waist line and to the left of center):