Before reading this section, please refer to General instructions after surgery in this section of the website.

Your child has just undergone an ACE procedure (Antegrade Continent Enema), which entails bringing your child's appendix or a segment of intestine connected to the colon up to the skin of the abdominal wall. This hole on the abdominal wall will permit your child to place a tube into the first portion of the colon and flush the entire bowel clear of stool with water.

The procedure was performed either by opening the abdominal cavity or by using a laparoscope, and this requires a brief hospital stay after surgery. Most children go home with a small catheter through the new channel, and irrigations are begun as soon as a regular diet is resumed. The catheter is sewn to the abdominal wall, and this will be removed at the first post-operative visit in the office, usually in 2 to 3 weeks.

After the catheter is removed, your child will be taught how to insert a reusable silicone catheter into the channel and irrigate the bowel. The most important rules are to use plenty of KY Jelly and to be gentle. The tube should never be forced if there is resistance. Mild oozing of blood is common, but call us if any frank bleeding occurs.

Flushes should be performed nightly after discharge, and we usually recommend using boiled, cooled tap water. The actual amount of fluid your child will ultimately use to evacuate the colon will vary, so start out with just 120 cc for the immediate post-operative period. If this does not induce any bowel movement, increase the amount to 180 cc. If you still fail to cause a bowel movement, please let us know. It may take several months before we figure out the exact amount of fluid necessary to cleanse the bowel; it varies from child to child.

Flushing the ACE should not cause any pain. If it does, please let us know. Some children will be able to feel distension of the colon when fluid is placed into it. If, despite have the ACE, constipation occurs, this commonly leads to some discomfort. It may be necessary to administer enemas from below to clean out the colon.

Leakage from the ACE can be very distressing. It is not uncommon, and it is a potential risk of the operation. The amount of leakage will depend on the natural length of your child's appendix. Mucous-like drainage from the hole is expected, and most people keep it covered with a Band-Aid or a small piece of gauze. If the colon is packed with stool, any fluid put into the ACE may leak back out, sometimes with distressing force. If leakage is occurring to the extent that it is creating problems, try using smaller amounts of fluid spread out over a longer period.

One of the long-term risks of the operation is narrowing of the channel on the abdominal wall. If your child is having trouble placing the catheter into the channel, please let us know immediately.