Jump to content. Antegrade Continence Enema Malone or ACE Procedure Children with severe fecal incontinence, severe constipation or no anal control as a result of spinal cord trauma, can experience dramatic improvements in their lifestyle with an Antegrade Continence Enema ACE. The technique is sometimes also referred to as a cecostomy tube, appendicostomy tube and the Malone Antegrade Continence Enema MACE after the surgeon who popularized the method. The pediatric surgery team at C.
The antegrade continence enema procedure and total anorectal reconstruction
Antegrade Continence Enema - ACE Procedure | CS Mott Children's Hospital | Michigan Medicine
This usually uses the appendix to create a channel from the skin into the large bowel at a point called the caecum. The fluid used to wash out the bowel can then be inserted easily. This fluid flushes the faeces out through the rectum in the usual way. This is called a stoma artificial opening. If your child has already had their appendix removed or if it is not suitable, the surgeon may need to use another method to create the passage. Your child will come back to the ward to recover. Do not rub the stoma site as this will make it sore.
Long-term Follow-up of Patients After Antegrade Continence Enema Procedure
Patients may present with anal incontinence AI following repair of a congenital anorectal anomaly years previously, or require total anorectal reconstruction TAR following radical rectal extirpation, most commonly for rectal cancer. Others may require removal of their colostomy following sphincter excision for Fournier's gangrene, or in cases of severe perineal trauma. Most of the data pertaining to antegrade continence enema the ACE or Malone procedure comes from the pediatric literature in the management of children with AI, but also with supervening chronic constipation, where the quality of life and compliance with this technique appears superior to retrograde colonic washouts. The advantages and disadvantages of these techniques and their outcome are presented here. Anal fecal incontinence AI is characterized by uncontrollable episodes of an involuntary loss of stool at inappropriate times and in socially unacceptable circumstances [ 1 , 2 ].
Antegrade continence enema ACE has become an important therapeutic modality in the treatment of intractable constipation and fecal incontinence. There are little data available on the long-term performance of the ACE procedure in children. A retrospective review of patients who underwent the ACE procedure was conducted. Irrigation characteristics and complications were noted. Outcome was assessed for individual encounters based on frequency of bowel movements, incontinence, pain, and predictability.