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An antegrade continence enema is a different way to give an enema. Enemas can help someone poop if they become constipated or have another problem moving their bowels.
The most common type of enema (EN-eh-muh) puts liquid directly into the rectum, the last part of the large intestine, to help release poop. It's simple to do and does not involve any kind of surgery. But because these start at the end of the large intestine (also called the colon or bowel) rather than the beginning, they work backward from how we move our bowels naturally. Usually, poop (or feces or stool) moves from the start of the large intestine, through the rectum, and out of the body via the anus.
An antegrade (which means "forward moving") continence enema starts at the beginning of the large intestine, so poop moves out of the body more normally.
In children, an antegrade continence enema can treat fecal incontinence that happens because of serious health problems. Fecal incontinence is when a child can't control his or her bowels. This doesn't just mean pooping accidents — most kids with fecal incontinence have severe constipation.
In most cases, doctors consider an ACE only when fecal incontinence (FEE-kul in-KAHN-tih-nentz) is severe and hasn't responded to other treatments. Less-invasive treatments work for most kids, such as dietary changes, laxatives, suppositories, and traditional enemas.
An ACE is helpful for kids who need long-term enema therapy. It lets them control their enemas through a tube that passes through the abdominal (belly) wall.
An ACE often works well for a child with:
The two types of antegrade continence enemas most often used for children are:
Appendicostomy (ah-pen-di-KOSS-tuh-mee) surgery makes a path from the belly button into the large intestine (colon).
An appendicostomy is often called a "Malone antegrade continence enema (MACE)" or a Malone. In this procedure, a surgeon creates a hole (or ostomy) in the skin of the belly that connects to the appendix and leads to the colon.
The appendix is a small, finger-like tube attached to the cecum (SEE-kum). The cecum is the first part of the colon. An appendicostomy lets the enema liquid go in here, instead of through the rectum.
For a cecostomy (see-KOSS-tuh-mee), a surgeon creates a hole (ostomy) in the skin of the belly that opens directly into the cecum, the first part of the colon.
The surgeon places a tube into the hole called a cecostomy tube, C-tube, or Chait tube. The cecostomy tube lets poop be flushed quickly and completely out of the large intestine. The enema fluid goes into a bag, then travels through tubing into the cecostomy. From the cecostomy tube, the fluid passes into the cecum. This encourages a bowel movement (BM).
Parents usually begin helping kids use their ACE at home about 1 week after the cecostomy.
When a child has an ACE:
A successful ACE:
A team of specialists that includes a pediatric surgeon usually treats children who have trouble pooping or poop accidents. Working with an experienced surgeon is important because slight differences in how the surgery is done can make a big difference in how well the ACE works.
The pediatric surgeon will discuss the risks and benefits of an appendicostomy, cecostomy, and other options. Together, you'll decide which is best is best based on your child's age, activities, and health problems.
You'll sign a consent (permission) form. The surgery team will talk to you about:
On the day of surgery, the preparation (pre-op) team:
Most appendicostomies are done using two or three small cuts and a tiny camera (laparoscopy). The surgeon typically:
If your child's appendix was removed or isn't long enough, the surgeon will make a tube from a piece of your child's colon.
The surgeon usually removes the tube about 2 weeks after the surgery and replaces it with a stopper.
Doctors usually use one or more of these minimally invasive techniques to create a cecostomy:
Steps for creating a cecostomy include:
The capped tube:
No. You may stay in the preparation (pre-op) area until the team moves your child to the operating room. You'll move to a waiting area during the surgery, then join your child in the recovery area after it's done.
Cecostomy surgery usually takes less than an hour. Appendicostomy surgery usually takes about 2 hours.
Your child will stay in the hospital for 2–3 days. During this time:
Doctors suggest replacing the cecostomy tube every 12–15 months.
Any surgery can cause unexpected bleeding or infection. Rarely, these problems may be life-threatening. Fixing some problems may mean doing another surgery.
Risks with an appendicostomy can include:
Risks with a cecostomy can include:
The best ways to help your child are:
After the surgeon removes the tube from your child's appendicostomy:
After the doctor says to begin using the cecostomy:
Fecal incontinence, no matter the cause, is upsetting for kids. It affects their quality of life and can be embarrassing, especially if a child has poop accidents. This can make kids feel isolated and alone, and lead to depression, behavior problems, and trouble at school. Soiling also can make kids an easy target for bullies.
An ACE can help end fecal incontinence. But because kids who have one don't poop the way other kids do, emotional issues can still happen. Help your child focus on the benefits of the ACE, such as:
Call your child's surgery team if:
Taking care of your child's ACE can feel like a challenge. But you don't have to go it alone. Your child's care team has answers and can connect you with resources.
You also can find support online at:
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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