The Kock pouch is a form of continent ileostomy, an internal bag collecting waste in place of the large intestine and colon. This procedure provides continence by allowing the patient to empty the Kock pouch through a hole in the abdomen at any convenient time. After removing the large intestine and colon, the pouch is created from an end segment of the small intestine. A few original design flaws have been corrected to now make this procedure a good continent ileostomy option. The procedure was developed by Dr. Nils Kock to replace ileostomies with external bags, which can inhibit normal day-to-day life.
When the large intestine and colon have been damaged and need to be removed, a Kock pouch can be made to collect the waste material in their place. A length of the small intestine is folded and sutured to create the pouch. An opening in the abdominal wall, called a stoma and typically located just above the pubic area, is then connected to the pouch inside. The pouch is drained by inserting a tube into the stoma and releasing the waste into the toilet. Draining of the pouch is done about three to five times a day at any time which is convenient for the patient.
Since its first use in 1969, the Kock pouch has evolved to address some of the problems associated with the earliest procedures. At first, some patients were incontinent and leaked waste through the stoma. To correct this, a special nipple valve was created which prevented both the spontaneous outflow of waste and the flow of water into the pouch while swimming or bathing. Another problem causing incontinence was slipping of the valve, and was fixed by wrapping the valve with a length of the intestine, a procedure known as the Barnett modification. As the intestine fills with waste, it tightens on the valve to help hold it in place.
Continent ileostomies, such as the Kock pouch, have many advantages. The patient is not encumbered by an external collection bag that needs to be contained under clothing and emptied and replaced periodically. Instead, the exit to the Kock pouch is flush with the skin and can be covered and hidden with a skin-colored patch. The Kock pouch virtually never leaks and can be emptied with just a small tube into the toilet. With this pouch, the patient has the freedom to exercise, travel, and work just like they did before the surgery.
