Kock pouch dysfunction during pregnancy. Management of a case

The Kock continent ileostomy is a surgical alternative to a Brooke ileostomy after total proctocolectomy. Complications resulting from an improperly functioning nipple valve are not infrequent and when they occur most often require surgical revision. A 19-year-old female with a functioning Kock pouch of 4 years presented at 6 months of pregnancy with complete bowel obstruction due to nipple valve dysfunction. Operative management was avoided and her bowel obstruction was relieved by endoscopic placement of a stent through the nipple valve and into the abdominal reservoir. The stent was removed at 1 week postpartum with immediate return to normal function of her Kock pouch nipple valve. Temporary malfunction of the Kock pouch nipple valve can occur during pregnancy, probably due to distortion of the valve mechanism by the enlarging uterus. The endoscopic placement of a stent can maintain proper bowel evacuation until delivery and normal Kock pouch function can be expected after stent removal.