Caring for a Patient with a Continent Ileostomy During and After Liver Surgery

Background:  In the 1960’s a patient requiring proctocolectomy surgery for ulcerative colitis or Crohn’s Disease needed a permanent ileostomy^3,4,.  A continent ileostomy pouch developed in 1967 by Dr. Nils Kock gave patients another option⁴.  After surgery, a patient would intubate the stoma with a catheter to evacuate the pouch 3-4 times daily³.  By 1980, this procedure was replaced by the ileal pouch anal anastomosis continent diversion commonly seen today^1,2,5.   Statement of Clinical Problem:  A 55 year old female patient with Crohn’s disease and a Kock pouch since 1978 was diagnosed with liver cancer.  She required a liver resection immediately.  The nurse practitioner, unfamiliar with the Kock pouch, consulted the certified WOC nurse to develop a plan of care.  Description of Past Management:  Literature to guide the care of this patient was limited.  She felt strongly that nurses would fail to keep the pouch decompressed without a plan.  She would spend several days in the intensive care unit intubated and unable to care for the pouch herself.  She knew the pouch was rare and feared nurses’ lack of knowledge related to continent ileostomy care may cause untoward events.   Current Clinical Approach: In order to keep the continent ileostomy stoma intubated during surgery and postoperatively, a two piece ostomy pouch, a 28 French urology catheter, suture and pink tape were used.  The suture was tied around the catheter and attached between the flange of the ostomy pouch at 3 and 9 o’clock.  The tape was placed on the tube at the os of the stoma which prevented movement of the catheter.  Patient Outcomes:  The catheter drained into the ostomy pouch.  The continent ileostomy did not become distended.  This system remained intact five days until the patient was able to intubate the stoma.  Conclusions:  While the patient was incapacitated, this method worked seamlessly.