Late Complications

Abstract

Kock’s continent ileostomy is associated with a wide variety of complications ranging from stoma complications surgically treated at the skin level or medically treated pouchitis to severe complications requiring re-laparotomy and even pouch excision. The more severe complications include nipple valve slippage, stoma site hernia, prolapse, fistulas, bowel obstruction, valve necrosis, perforations, and dislocation of the pouch from the abdominal wall. It is widely accepted that the complication rate for continent ileostomies is high with reported revision rates between 11 and 72% and pouch failure is reported in between 5% and 40% of cases. Patients with late complications usually complain of incontinence of the pouch and/or difficulties intubating the pouch with the Kock catheter. Other less common problems may be pain at intubation or development of peristomal fistulas or even bulging. These symptoms warrants further investigations and apart from a thorough patient history the use of a CT scan (or MRI) and especially endoscopy of the pouch may be of help in finding the cause (Figs. 14.1, 14.2, 14.3 and 14.4).