Endoscopic Retrieval of Retained Irrigation Tubing from a Barnett Continent Intestinal Reservoir

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Continent ileostomy, including Kock pouch and Barnett continent ileostomy reservoir (BCIR), is an alternative to conventional (Brooke) ileostomy following total colectomy. Because these procedures are performed infrequently and primarily at specialized centers, many providers may have limited familiarity with their anatomy and management. We present the case of a 61-year-old man with a history of ulcerative colitis who underwent total abdominal colectomy with BCIR creation. He presented after accidental retention of irrigation tubing within the pouch during routine catheterization. Gastroenterology was consulted for ileoscopy; however, endoscopic evaluation was initially deferred because of concern regarding the small caliber and atypical appearance of the continent stoma. The patient was brought to the operating room, where digital examination of the stoma demonstrated a patent stoma without evidence of stenosis or stricture, and endoscopic access through the stoma was achieved without difficulty. Approximately 30 cm of retained irrigation tubing was successfully removed using an endoscopic grasper. This case highlights an unusual complication of continent ileostomy catheterization and demonstrates that endoscopic access through a BCIR stoma may be feasible and safe in appropriately selected patients. Increased familiarity with continent ileostomy anatomy may help reduce uncertainty in management and avoid delays in intervention.