The continent ileostomy (Kock pouch) unlike the standard ileostomy consists of an intra-abdominal ileal reservoir and a continent valve.1 The Kock pouch has significant advantages over the standard ileostomy as it is appliance free and may be more acceptable individually and socially.2 This continent ileostomy is associated with complications including the following: valve malfunction, hernia, intestinal obstruction, abscesses, fistulae, reoperation, and in some cases pouch removal.3-5 Bacterial overgrowth secondary to the stasis may additionally result in pouchitis. This inflammatory condition is clinically characterized by pain, fatigue, nausea, fever, and increased ileostomy output that typically responds to antibiotic therapy.6 We describe an unusual Kock pouch complication in three patients.