Radiological assessment of nipple-valve insufficiency in Kock's continent reservoir ileostomy

In a series of 51 continent reservoir ileostomies nipple-valve insufficiency developed in 15 patients who were examined radiographically to find the cause for the loss of continency. The radiological diagnosis was confirmed at reoperation. The caused for nipple-valve insufficiency were a total or partial disappearance of the nipple-valve by sliding of the invaginate (7 cases) and dislocation of an undamaged nipple out of the reservoir (8 cases). In these groups the radiological diagnosis was compatible with the operative findings in all but one case. At reoperation a fistula in the nipple-valve was found in 3 cases, but in no instance had this been diagnosed radiologically. A correct preoperative diagnosis is valuable, especially in cases of dislocation, where a danger exists that the real mechanism of valve insufficiency may remain obscure at operation. (author)