The most common postoperative complication after formation of a continent ileostomy (Kock pouch) is which of the following?

a. Nipple valve failure

The continent ileostomy has been associated with a high postoperative complication rate. Most complications are related to displacement of the nipple valve, producing fecal incontinence and difficulty in intubating and emptying the pouch. Valve failure has been reported to occur in up to 40% of patients. Ten to 20% of patients suffer postoperative bowel obstructions. Several syndromes of ileostomy dysfunction related to Cock pouch have also been reported. These are variably described as stagnant loop syndrome, pouchitis, and nonspecific ileitis. Clinical features include diarrhea, malabsorption of fat and vitamin B12, proliferation of anaerobic bacteria, inflammation of the pouch, and incontinence. Crohn’s disease is a clear contraindication to performing this operation, as the rate of postoperative complication is much higher in this group.