Rla

Figure 5.37. Parastomal hernia. (A) Frontal film from a retrograde small-bowel study performed through an ileostomy shows what appears to be normal anatomy at the stomal site. Note the use of a cone ostomy device rather than a catheter to cannulate the stoma. (B) Steep oblique film not only reveals a large parastomal hernia, but a second loop of herniated bowel superiorly.

Figure 5.37. Parastomal hernia. (A) Frontal film from a retrograde small-bowel study performed through an ileostomy shows what appears to be normal anatomy at the stomal site. Note the use of a cone ostomy device rather than a catheter to cannulate the stoma. (B) Steep oblique film not only reveals a large parastomal hernia, but a second loop of herniated bowel superiorly.

The pouch comprises of three loops of ileum that are configured in an "S" shape. The bowel is opened along its antimesenteric border and then the contiguous portions of two loops are sutured together, creating a large saccular reservoir. The opposed nature of the loops prevents peristalsis from emptying the pouch [110,111]. Instead of an everted stoma, the terminal end of the pouch is retrograde intussuscepted into the pouch, creating a valve that further prevents inadvertent emptying of the pouch [110] (Figs. 5.38 and 5.39). Emptying is performed by intermittent catheterization. The entire pouch is anchored to the anterior abdominal wall.

Lycke and colleagues have noted that the radiological evaluation of the normal pouch includes examining the pouch (or reservoir) itself, the valve, and both the afferent and efferent ileal loops [110]. Over time, the reservoir gradually increases in capacity from 100 ml to 700 ml. On

Efferent limb

Figure 5.38. Kock contintent ileostomy. Schematic drawing reveals details of the construction of a Kock pouch. In this example, three loops of bowel have been brought together to form a large reservoir. The efferent limb has been retrograde intussuscepted into the pouch to form a nipple, which maintains continency.

Efferent limb

Figure 5.38. Kock contintent ileostomy. Schematic drawing reveals details of the construction of a Kock pouch. In this example, three loops of bowel have been brought together to form a large reservoir. The efferent limb has been retrograde intussuscepted into the pouch to form a nipple, which maintains continency.

Figure 5.39. Kock pouch. (A) Supine film of the abdomen shows a large air collection in the right lower quadrant. Some bowel markings are present. Within the air collection is a round soft tissue density representing the intussuscepted nipple within the pouch. A catheter can be seen entering the nipple. (B) Upright abdominal film on the same patient reveals the large saccular configuration of the pouch brought about by uniting multiple small-bowel loops to form a large reservoir.

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