An alternative to conventional ileostomy, a continent, or pouch, ileostomy (also called a Koch ileostomy or an ileal pouch) features an internal reservoir fashioned from the terminal ileum. This procedure may be used for a patient who requires proctocolectomy for chronic ulcerative colitis or multiple polyposis. Other patients may have a traditional ileostomy converted to a continent ileostomy. This procedure is contraindicated in Crohn’s disease or gross obesity. Patients who need emergency surgery and those who can’t care for the pouch are also unlikely to have this procedure.

The length of preoperative hospitalization varies with the patient’s condition. Nursing responsibilities include providing bowel preparation, antibiotic therapy, and emotional support. After surgery, nursing responsibilities include ensuring patency of the drainage catheter, assessing GI function, caring for the stoma and peristomal skin, managing pain resulting from surgery, and, if necessary, perineal skin care.

Patient teaching on pouch intubation and drainage usually begins soon after surgery. Continuous drainage is maintained for about 2 to 6 weeks to allow the suture lines to heal. During this period, a drainage catheter is attached to low intermittent suction. After the suture line heals, the patient learns how to drain the pouch himself.