Psychiatric casualties following revision to the "continent" Kock ileostomy

The advantages of the appliance-free "continent" Kock ileostomy over the conventional ileostomy may result in its earlier and more frequent use in treating ulcerative colitis. Caution must be observed in selecting patients for surgery because of the high incidence of psychological problems in this population. Increased restraint is especially indicated as such surgery may no longer be reserved for life-threatening or incapacitating conditions. As the Kock operation becomes more widely known, patients with conventional ileostomies are requesting revision to the reservoir. This paper addresses itself to unexpected problems that may arise in this group. Two cases are presented of men who made tenuous adjustments to the primary surgery but for whom revision to the continent ileostomy proved psychologically catastrophic. Psychiatric evaluation is urged in the absence of clear-cut medical indications for revision. Suggestions concerning selection of patients who seek such change are offered.