Antegrade Continence Enema - ACE Procedure

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.S. Mott Children’s Hospital has specialized expertise with the ACE procedure, including offering a high level of support to patients and families to help them maximize their child’s quality of life. ACE involves a minimally invasive surgical procedure where two or three small incisions are made on the abdomen. The surgeon then places a catheter (tube) into the right side of the child’s colon through either the appendix or cecum. This tube is then used daily to flush out the colon. Most children spend one or two days in hospital following the surgery.

When the tube is inserted into the appendix, it is known as an appendicostomy. During this procedure, the appendix is brought onto the abdominal wall. This procedure is most often used for children with long-term needs. When the tube is placed directly into the large bowel area of the cecum, the procedure is known as a cecostomy. This is generally a more temporary approach and works well for children with severe constipation.

Following the surgical insertion of the catheter, the family flushes out the colon each day by injecting fluid into the catheter. Our Mott team helps family members learn how to perform this daily routine. The ACE is better than a daily enema for these children because it avoids the painful insertion of the enema tube into the rectum. It also allows you to flush out stool higher in the colon so there are far fewer accidents.

In about 90 percent of children, ACE leads to a marked improvement in accidents and soiling. It will take some time to adjust and figure out the correct volume of fluid and the timing of the flushes to best minimize the risk of accidents. Once a family has a routine that works well for them, children experience great improvements in their quality of life. They are better able to participate in after-school activities and even sleepovers.

Discover the Michigan Difference in pediatric colorectal surgical care. For more information or to make an appointment, call 1-877-475-MOTT (1-877-475-6688).