• Kock’s Pouch is created as a continent ‘ileostomy’

• It contains a ‘valve’ and the large Pouch.
   
• The valve is made from small bowel which has been intussuscepted to create the valve.
   
• Patients use a large Medina catheter to empty the Kock’s pouch when necessary.
  
   
• Complications of pouch include:

• Slipped valve; making it difficult for patient to intubate the pouch
   
• Enterolith formation in the pouch
   
• Stenosis of the ‘afferent limb’ (small bowel entering the pouch)
   
• Stenosis of the pouch (Delayed diagnosis of Crohn’s disease)
   
• Pouchitis (A clinical diagnosis - but may show thickened folds in pouch).
   

Procedure:

• Use a Foley catheter
   
• Water soluble contrast or dilute barium (1/3 barium 2/3 water)
   
• May need a large Medina catheter

SCOUT AP VIEW Shows a calculus within the Kock’s pouch	SCOUT LATERAL VIEW
POUCHOGRAM LATERAL OBLIQUE VIEW A catheter has been inserted into the lumen of the valve and contrast shows the outline of the cutaneous portion of the valve.	POUCHOGRAM LATERAL OBLIQUE VIEW The catheter has been advanced further in to outline more of the valve.
POUCHOGRAM LATERAL OBLIQUE VIEW The catheter has been advanced further into the pouch. More contrast is instilled which outlines the valve to better advantage. Notice there is some contrast outlining the superior portion of the valve. This is suggestive of a ‘slipped valve’.	POUCHOGRAM LATERAL OBLIQUE VIEW
POUCHOGRAM LATERAL OBLIQUE VIEW Withdraw the catheter and drip contrast again to show the entire Kock’s valve (dotted line).	POUCHOGRAM LATERAL OBLIQUE VIEW Then withdraw the catheter and drip contrast again to show the entire Kock’s valve