Sometimes medications are unable to cure or control certain illnesses, and surgery is necessary. When a patient experiences removal of the large intestine (colon) and rectum, the procedure is known as a proctocolectomy. One of the ways surgeons enable the body to expel waste after this surgery is use of a Kock pouch.
Patients with a number of disorders undergo proctocolectomies. Among the conditions most frequently linked to this surgery are Crohn’s disease, ulcerative colitis, cancer and familial adenomatous polyposis.
After a surgeon performs this surgery, waste passing through the small intestine still needs an exit. The traditional method is creating an opening in the abdominal wall. The end of the small intestine is pulled through the opening to form a stoma, typically on the lower right side of the patient’s abdomen, according to the American Cancer Society. Waste empties into a bag attached temporarily to the body. This is known as a Brooke ileostomy.
For ulcerative colitis patients, it’s possible to create an alternative without any external opening. The Cleveland Clinic says that to create an ileoanal J-pouch, a surgeon makes an internal pouch from the small intestine and connects it to the anus. Removing the colon cures ulcerative colitis but not Crohn’s disease, a second inflammatory bowel disorder. Due to the recurrent nature of Crohn’s, doctors use a J-pouch for that condition infrequently.
According to KockPouch.com, these remedies are the brainchild of Nils G. Kock, a physician born in Finland in 1924. In 1969, he described a novel way to create an internal pouch made from the end of the small intestine. The patient still had an opening in the abdominal wall through which waste passed.
However, rather than using a bag attached to the body, the patient drained the pouch several times a day by inserting a catheter into it. Between these events, it was only necessary to cover the opening with a small bandage to absorb mucous manufactured by the lining of the small bowel.
Patients reported increased self-esteem and image from this procedure versus a Brooke ileostomy. The cost was also less because there was no need to purchase bags.
Over the years, there have been a number of improvements in Kock pouches. One of the major problems has been keeping the valve in the correct position.
Many patients are able to convert their Koch pouches to Barnett continent intestinal reservoirs. The transition usually preserves the pouch but creates a new stoma with a new valve. Patients with Kock problems can keep a continent ileostomy without reverting to a traditional external bag.