The Use of Antegrade Colonic Enema (ACE) Procedure in the Management of Faecal Incontinence in Children Following Unsuccessful Anorectal Malformation Surgical Correction

Faecal incontinence and intractable constipation can be devastating to the emotional and social development of children. Anorectal malformations affect 1 in 5000 newborns and at least 30% of these children will be faecally incontinent after corrective surgery. Options available for this condition were either continuing incontinence or colostomy formation, if a redo surgery is not planed. Antegrade continence enemas (ACE) delivered through a cecostomy button or catheterizable stoma can be an efficacious surgical option. The Malone ACE procedure can be a solution in these conditions, it gives a better quality of life and most patients and parents are satisfied after the procedure. Material and Methods: During the period from 2005 to 2007, 14 patients underwent the continent appendicostomy procedure. The age of the children ranged from 6 to 12 years (mean age was 9 years), all of them had two staged surgery for high anorectal malformation. All had Posterior Sagittal Ano-Reco Plasty (PSARP) procedure done at the age from 6 to 18 months after initial defunctioning sigmoid colostomy. After closure of colostomy, none of the patients developed continence. Results: 13 out of the 14 patients were satisfied after getting used to the antegrade colonic enema and their quality of live improved and psychologically satisfied (93%). Stomal stenosis accrued in 2 patients, leakage from the stomal site after the antegrade enema was troublesome in 5 patients and soiling occurred and lasted for more than one hour in 3 patients. Conclusion: Malone Antegrade Colonic Enema is a method to keep the child with incontinence clean, more socially active and with a better quality of life. ACE procedure provides what is called as Social Continence in children with unsuccessful correction of anorectal malformations. To convert an introverted, faecally incontinent child in a nappy into a nearly normal child in pants, without the need to a colostomy bag, is immensely satisfactory.