A reappraisal of the Kock continent ileostomy in patients with Crohn's disease.

The diagnosis of Crohn's disease has been considered a contraindication to the construction of a Kock continent ileostomy. From 1975 to 1984, 95 Kock continent ileostomies were performed at the Stanford University Medical Center. The clinical course of seven patients with regional enteritis who were disease-free for five years was reviewed. All of the patients studied were women, with a mean disease-free interval of 7.7 years and a range of follow-up study of four to 50 months. To date, all of the patients are fully continent to gas and ileal effluent. The postoperative complication and revision rate (28 per cent) was comparable with the results cited in the literature for individuals with ulcerative colitis or familial polyposis. When revisions were necessary, patients elected to keep the Kock pouch rather than conversion to a conventional Brooke ileostomy. The authors agree that active regional enteritis is to be considered a contraindication to the construction of a continent ileostomy. However, the benefits afforded a patient with a continent ileal reservoir are substantial and warrant consideration in a select group of patients with Crohn's disease who are disease-free for a minimum of five years.