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Kock pouch dysfunction during pregnancy. Management of a case
R D Curtis1, W B Sweeney, J W Denobile
1Department of Surgery, National Naval Medical Center and the Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA.
Surgical Endoscopy
|July 1, 1996
Summary
Pregnancy can cause Kock pouch nipple valve dysfunction, leading to bowel obstruction. Endoscopic stenting offers a temporary, non-surgical solution, restoring function postpartum.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Reproductive Medicine
Background:
- The Kock continent ileostomy is a surgical option for patients requiring a total proctocolectomy.
- Nipple valve dysfunction in Kock pouches can necessitate surgical revision.
- Pregnancy presents unique physiological challenges that may impact surgical reconstructions.
Observation:
- A 19-year-old female with a 4-year-old Kock pouch experienced complete bowel obstruction at 6 months gestation.
- The obstruction was attributed to nipple valve dysfunction, likely exacerbated by uterine enlargement.
- Endoscopic stenting was successfully employed to bypass the dysfunctional valve and relieve the obstruction.
Findings:
- Endoscopic stent placement provided a non-operative resolution for bowel obstruction caused by Kock pouch nipple valve dysfunction during pregnancy.
- The stent facilitated bowel evacuation throughout the remainder of the pregnancy.
- Following stent removal postpartum, the Kock pouch nipple valve resumed normal function.
Implications:
- Endoscopic stenting is a viable temporizing measure for managing Kock pouch nipple valve dysfunction during pregnancy.
- This approach avoids surgical intervention, preserving maternal and fetal well-being.
- Normal Kock pouch function can typically be restored after delivery and stent removal.