Malone antegrade continence enema for faecal incontinence and constipation in adults

Abstract

Background: In the Malone antegrade continence enema (ACE) technique the appendix or a 'neoappendix' created from the caecum is brought to the abdominal wall creating a small stoma. Thereby, antegrade enemas can be administered to empty the colorectum and prevent faecal incontinence or constipation in children with congenital malformations. The aim of this study was to describe the results of the ACE in adults suffering from faecal incontinence or constipation.

Methods: In 16 adult patients (ten women and six men) suffering from severe faecal incontinence (ten patients) or constipation (six patients) the ACE procedure was performed; the appendix was used in 12 and a 'neoappendix' was created in four. Patient records were used for the description of surgical procedures and complications. Results were evaluated by a structured telephone interview.

Results: After a follow-up of 1-39 (mean 17) months, four patients had stopped using the stoma because of abdominal pain or lack of effect. Among the other 12 patients overall satisfaction with the stoma was high or very high. In constipated patients mean time for defaecation was reduced from 170 to 45 min. Faecal incontinence was much reduced in eight patients; the impact on social activities and quality of life caused by bowel dysfunction was reduced in all 12 patients.

Conclusion: The ACE technique can be used to treat selected adult patients suffering from faecal incontinence or constipation.