This chapter presents a case study of a 50-year-old male with a 32-year history of ulcerative colitis presented with rectal bleeding and tenesmus to illustrate the best care and clinical management of patient requiring late reconstruction with continent Kock ileostomy. It presents a consistent approach throughout and as well as outlining the actual management of the case, also offers an honest appraisal of the chosen management route, its successes and areas that could have been managed differently. Pedagogic features such as learning and decision points boxes aid rapid understanding/learning, enabling the reader to improve their patient management.