person holds drawing of colon and intestinal tract over abdomen
person holds drawing of colon and intestinal tract over abdomen
person holds drawing of colon and intestinal tract over abdomen

Antegrade Colonic Enema (ACE)

What is an A.C.E.?

A.C.E. stands for Antegrade Colonic Enema. An A.C.E. procedure will allows the patient to do a total washout of their colon by flushing out stool starting in the colon downward. This produces a bowel movement under the patient's control.

Who may benefit from an A.C.E.?

Patients who have or have had the following:

  • Myelomeningocele
  • Spina Bifida
  • Imperforate Anus
  • Quadriplegia
  • Other problems causing neurogenic fecal incontinence or intractable constipation
  • Medical management that has not helped control their bowel movements

How is an A.C.E. used?

A very small opening (ostomy) is made in the patient's belly button or lower tummy. This opening can be made so small that it is barely visible. The ostomy is used to flush a saline solution into the patient's colon to wash it out and produce a bowel movement. This may be done daily, every other day, or 2-3 times a week, depending on how often cleansing is needed. Staying on a good schedule will help keep the patient's underclothes clean in between flushes. This ostomy is called a “continent ostomy,” which means that fluids only go into the opening. It is not made for stool to come out of.

For the ACE Patient:

What should I expect?

First, you will be admitted to the hospital. Before surgery you will be given something to cleanse your bowels. You will also need to have antibiotics to help prevent infection.

On the day of surgery, you will meet with the anesthesiologist who will give you medicine to help you sleep until surgery is finished.

During surgery, the surgeon will make your ostomy using your appendix or your small intestine. When the surgeon is finished, they will put a soft, flexible catheter in place to help the ostomy heal properly. Remember, you will be asleep and won’t feel anything!

Afterwards, the surgeon will go talk to your family while you are sleeping to tell them you are finished with surgery. You will then go to the recovery room until you wake up.

When you wake up you will go back to your room and your family can be with you. It is possible that you may have some additional medicines and tubes around you such as:

  • Oxygen, if needed
  • A pulse oximeter taped to your finger to measure your oxygen level
  • A bag of antibiotics in your IV
  • A tube in your nose to help keep your tummy empty until it wakes up, too
  • An epidural catheter with pain medicine to keep you comfortable
  • A urine catheter to keep you from having to walk to the bathroom
  • A bandage on your tummy

Some of these may be taken off that same day. Others may stay for a few days while your tummy wakes up and you can tolerate food well.

You will be in the hospital about 1 week. Before you leave, you nurse will show you how to flush using an enema bag and a saline solution.

What happens next?

When you go home from the hospital, you will need to keep your A.C.E. clean. You will begin flushes every day for a while. The catheter the surgeon put in during surgery will need to stay in place for about 4 weeks. Then the surgeon will see you in his or her office and take out the catheter. Taking it out is very quick. It may feel a little strange, but it does not hurt. You will also be shown how to put another catheter in to do your flushes and how to take it out again. 

As you get more comfortable with using the A.C.E., you will be able to set a routine time to do your flushing. It is VERY IMPORTANT to put the catheter in your ostomy once a day, even if you are not flushing. This helps to keep it from closing up. The A.C.E. can be made to last as long as you need it, if properly taken care of.

Once you have healed up and are back to your regular activities, in about 4-6 weeks, you will feel much better! You will now be able to “schedule” when you have a bowel movement. You should also see fewer to no soiled underclothes. If you were constipated, you may even have a better appetite, fewer tummy aches and headaches, too!

The A.C.E. has helped many children, teens and adults feel better and have an improved quality of life.

Pediatric Care at Johns Hopkins Medicine

  • Pediatric Surgery at Johns Hopkins All Children's Hospital

    The Division of Pediatric Surgery at Johns Hopkins All Children's Hospital, based in St. Petersburg, Florida, provides a wide range of services including advanced miniature access and minimally invasive surgery, neonatal surgery, congenital diaphragmatic hernia surgery, chest wall deformity surgery, ambulatory wound services and oncology surgery.

  • General Pediatric Surgery at Johns Hopkins Children's Center

    The specialists in the Division of General Pediatric Surgery at the Johns Hopkins Children’s Center in Baltimore, Maryland, understand the special needs of children and are world-renowned for their unique surgical expertise and skills. The program is known nationally for both its innovative and minimally invasive approaches and its patient- and family-centered philosophy of care.

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