Abstract
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.
Similar content being viewed by others
References
Daniels GE, O'Conner JF, Karush A, Moses L, Flood CA, Lepore M: Three decades in the observation of ulcerative colitis. Psychosom Med 24:85–93, 1962
O'Conner JF, Daniels G, Karush A, Flood C, Stern LO: Prognostic implications of psychiatric diagnosis in ulcerative colitis. Psychosom Med 28:375–381, 1966
Boné J, Sorenson FH: Life with a conventional ileostomy. Dis Colon Rectum 17:194–199, 1974
Claman L, Trieschman A: Adjustment to surgery of children with ulcerative colitis. Am J Dis Child 107:131–137, 1964
Daly DW: The outcome of surgery for ulcerative colitis. Ann R Coll Surg Engl 42:39–57, 1968
White BJ: The effect of ileostomy and colectomy on the personality adjustment of patients with ulcerative colitis. N Engl J Med 244:537–540, 1951
Stahlgren LH, Ferguson LK: Influence on sexual function of abdominoperineal resection for ulcerative colitis. N Engl J Med 259:873–879, 1958
Lennenberg E, Rowbotham JL: The Ileostomy Patient. Springfield, Illinois, Charles C Thomas, 1970
Dlin BM, Perlman A, Ringold E: Psychosexual response to ileostomy and colostomy. Am J Psychiatry 126:374–381, 1969
Druss RG, O'Conner JF, Stern LO: Changes in body image following ileostomy. Psychoanal Q 41:196–206, 1972
Druss RG, O'Conner JF, Prudden JF, Stern LO: Psychologic response to colectomy. Arch Gen Psychiatry 18:53–59, 1968
Kock NG: Intra-abdominal “reservoir” in patients with permanent ileostomy. Arch Surg 99:223–231, 1969
Kock NG: Ileostomy without external appliances: A survey of 25 patients provided with an intra-abdominal intestinal reservoir. Ann Surg 173:515–520, 1971
Kock NG: Continent ileostomy. Prog Surg 12:190–201. 1973
Cameron A: The continent ileostomy. Br J Surg 60:785–790, 1973
Kock NG, Darle N, Kewenter J, Myrvold H, Philipson B: The quality of life after proctocolectomy and ileostomy: A study of patients with conventional ileostomies converted to continent ileostomies. Dis Colon Rectum 17:287–292, 1974
Beahrs OH, Kelly KA, Adson MA, Chong GC: Ileostomy with ileal reservoir rather than ileostomy alone. Ann Surg 179:634–637, 1974
Druss RG, Francis CS, Cirkelair GF: The problem of somatic delusions in patients seeking cosmetic surgery. Plast Reconstr Surg 48:246–250, 1971
Boyd I, Yeager M, McMillan M: Personality styles in the postoperative course. Psychosom Med 35:23–40, 1973
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Golden, H.K. Psychiatric casualties following revision to the “continent” Kock ileostomy. Digest Dis Sci 21, 969–973 (1976). https://doi.org/10.1007/BF01071909
Issue Date:
DOI: https://doi.org/10.1007/BF01071909