A Kock pouch is a surgical creation. It was the earliest type of continent ileostomy, a means by which waste can exit the body after removal of the large intestine (colon) and the rectum.
When Are Ileostomies Necessary?
Often ileostomy is the treatment of last resort, after medical therapies fail to sufficiently improve an individual’s health. According to the University of Maryland Medical Center, a variety of problems can necessitate an ileostomy. The most common include:
To create an ileostomy, a surgeon brings the lowest portion of the small bowel (ileum) through a stoma (opening) in the abdomen.
Types of Ileostomies
BCIRhistory.com reports that the use of ileostomies dates to 1913. The first so-called modern ileostomy was the Brooke ileostomy in 1952. This traditional procedure involves carefully selecting the site for the stoma on the patient’s abdomen, then bringing the end of the small bowel through the abdominal opening. A spout or nipple allows waste to flow into a bag attached to the patient’s body. While some patients experience a good quality of life with this procedure, others report poor ostomy function or developing hernias.
In 1969, the creation of a continent ileostomy gave patients another option and more control over their lives. The perfected result was the Kock pouch. This type of ileostomy involves creating a reservoir other than the typical stoma after removal of the patient’s colon and rectum. Individuals typically drain this continent ileostomy three to four times a day. This requires using a tube inserted into a reservoir and a special valve created from intestinal tissue in the wall of the abdomen. A small covering to absorb mucus from a flat stoma replaces an external bag.
Despite design improvements over the years, a significant percentage of Kock patients have experienced leakage, incontinence or difficulty inserting catheters. These problems typically require revision surgery. Some individuals reverted to the traditional Brooke ileostomy. However, another option exists – the Barnett modification of the Kock Pouch.
Barnett Continent Intestinal Reservoir
Many patients have had Kock procedures reversed in favor of the most recent, improved ileostomy known as the Barnett Continent Intestinal Reservoir (BCIR). The final design of this continent ileostomy dates to the 1980s.
The BCIR lowers the risk of developing fistulas and features a self-sealing valve and a design that prevents the nipple valve from slipping. Patients enjoy the convenience and control it provides.