Kock Pouch

What is a Kock pouch (K-pouch)?

The Kock pouch, or K-pouch, is a type of ileal pouch that you can have with an ileostomy. You might need an ileostomy if you have to have your large intestine removed (colectomy).

An ileostomy redirects the end of your small intestine, called the ileum, to an opening (stoma) in your abdomen so that you can pass waste from your body. With a stoma, you need a pouch to collect waste.

If you have a standard (Brooke) ileostomy, you’ll use an external pouch (ileostomy bag) that attaches to your stoma to collect your waste (poop). You’ll remove the pouch to empty it throughout the day.

The Kock pouch is an alternative, internal pouch that your surgeon can construct to hold your poop inside your body. It attaches to your stoma, and you can empty it at your convenience through a tube.

What is a Kock pouch used for?

The Kock pouch is an option for people who have to have a permanent ileostomy but don’t want to use an external ileostomy bag. It offers the ability to hold your poop inside your body and empty it at will.

An ileostomy with a Kock pouch is also called a continence ileostomy. That’s because it prevents the fecal incontinence that usually comes with a stoma — poop coming out any time.

What is a urinary Kock pouch?

The Kock pouch that we use as a fecal continence pouch today was originally designed as a urinary continence pouch. It was used to replace your bladder if you had to have your bladder removed.

A urostomy Kock pouch holds your urine and allows you to drain it through a catheter inserted into a stoma. It’s still in use, although many newer urinary reconstruction and diversion models exist today.

Why is it called a Kock pouch?

The Kock pouch is named for Nils Kock, the surgeon who invented it.

How do surgeons create a Kock pouch ileostomy?

Your surgeon can create your Kock pouch at the same time they create your ileostomy, or they can create it later in a separate surgery. You can have a Kock pouch procedure any time after an ileostomy.

To construct the pouch, your surgeon will:

• Measure out about four loops at the end of your small intestine (about 18 inches) and fold this end up against the upper part of the intestine in a long “U” shape.
• Open up the intestine in the middle of the “U” and stitch the edges of the lining together, leaving the last few inches unconnected. This creates a pouch with a “tail” at the end.
• Use the tail to create a one-way valve at the opening of the pouch. They do this by folding the tissue to create a flap and securing it with stitches. The flap closes when the pouch fills up.
• Attach the tail” with the valve to the inside of your stoma. They’ll test the valve to make sure that fluids, solids and gases don’t leak through the opening.

What happens after the Kock pouch procedure?

After K-pouch surgery, you’ll recover in the hospital for three to five days. During this time, you’ll have various tubes placed in different parts of your body to help you recover. These may include:

• IV fluids.
• IV nutrition.
• Wound drains.
• Urinary catheter.
• Pain pump.

The catheter in your stoma will stay in place for several weeks to drain fluids from your Kock pouch wound. A nurse will instruct you on caring for your catheter until a healthcare provider removes it.

How long does the recovery take?

You’ll spend a few weeks recovering at home before the wound drain can be removed. After that, a nurse will teach you how to drain your K-pouch with the regular catheter you’ll use from now on.

You’ll have to drain the pouch about eight times a day in the beginning. After a few months, when your pouch has fully healed and gradually enlarged, you’ll only need to drain it two to four times a day.

What are the benefits of the Kock pouch?

The primary advantages of a continence ileostomy over a standard ileostomy are:

• You don’t have to wear or manage an ileostomy bag.
• You can have a more discreet stoma, covered by a gauze pad or bandage.
• You can empty your bowels when you choose, without leaking throughout the day.
• It’s easier to sleep with, and you don’t have to empty it at night.

What are the potential complications of the Kock pouch?

Possible complications include:

• Valve complications. Sometimes the valve your surgeon created to keep your pouch closed slips over time, which can cause leaking. The leaked stool can irritate your skin. You might need revision surgery to fix it. A slipped flap can also obstruct the opening of the pouch and make it hard to intubate and drain it. A total small bowel obstruction would be an emergency.
• Fistulas. A fistula is an inappropriate tunnel that develops between parts of your body. Fistulas can develop from your pouch to your skin or other organs when the tissues between them are worn away. This usually happens because of persistent inflammation or loss of blood supply to the tissues. A fistula from your pouch can cause pain, infection and other complications.
• Pouchitis. Pouchitis is irritation and inflammation inside your pouch, usually due to an infection. It’s common with all types of ileal pouches. Most of the time, antibiotics can quickly relieve it. Rarely, some people develop chronic pouchitis. If this happens, the pouch may fail.
• Stricture/stenosis. Sometimes scar tissue at the opening of the pouch causes the opening to narrow (stricture or stenosis). This can make it hard to drain your pouch. If you can’t get your catheter in, you or a healthcare provider might have to stretch it using a dilator tool.
• Parastomal hernia. This type of hernia occurs when a loop of your intestine emerges through your stoma. A hernia can grow over time and may block the stoma’s opening. This would require revision surgery. The opening could also pinch your intestine, creating a blockage.
• Short bowel syndrome. If you have to have revision surgery for complications with your K-pouch — especially if your K-pouch was a revision surgery itself after another type of pouch failed — you run the risk of not having enough small bowel left after these surgeries. If you don’t have enough bowel, you might have difficulties digesting and absorbing enough nutrients.

What is the outlook with a Kock pouch?

Most people choose the Kock pouch to make their lives easier, and, by design, it does. Whether you’re converting from a standard ileostomy or a failed J-pouch, the K-pouch is an answer to several problems.

But the Kock pouch does have a higher rate of complications that require revision surgery than other pouches do — up to 30%. This is mostly due to valve failures, which are unique to the Koch pouch.

Despite these setbacks, most people report improved quality of life with the K-pouch. You’ll discuss your personal risks, alternatives and health thoroughly with your healthcare provider before going forward.

Should I adjust my diet while living with a K-pouch?

A balanced, nutritious diet will help you restore your overall health. You may have developed limited eating habits in the past to manage your chronic disease. Now you can start to broaden your diet again.

A registered dietitian can help you develop a personalized diet that meets your nutritional and hydration needs. If your stool is too thick or too runny, dietary adjustments can help with this, too.

What is the difference between the K-pouch vs. J-pouch?

The K-pouch was the first ileal pouch that was introduced for people having ileostomy surgery. It offered people living with a permanent ileostomy a way to maintain some control over their bowel movements.

The J-pouch is a newer breed of ileal pouch that offers an alternative to having an ileostomy at all. This ileal pouch attaches to your anal canal so you can poop the old-fashioned way, without a stoma.

Most people today who have to have their whole colon and rectum removed (total proctocolectomy) prefer the J-pouch. But for the J-pouch to work, you have to have a fully functioning anus (butthole).

The K-pouch remains an alternative for people who can’t have a “restorative” proctocolectomy that reconnects their bowel to their anus. It’s also a backup option if your J-pouch fails due to complications.

What is the difference between the Koch pouch and ileostomy?

A Kock pouch is an option that you can have with an end ileostomy. It’s the only ileal pouch that works with a permanent ileostomy. An ileostomy with a Kock pouch is also called a continence ileostomy.

A note from Cleveland Clinic

If you’re contemplating a Kock pouch, you’ve already made the bigger decision to have a major bowel resection. This should bring relief from the chronic disease that made your intestine unusable.

While proctocolectomy might save your life, the Kock pouch exists to improve your quality of life. When pooping is easier, everything is easier, and you can begin to reclaim more of your favorite activities.