Anterior continence enema for faecal incontinence

Aims: The anterior continence enema (ACE) is a novel method of treating faecal incontinence secondary to neuropathic bowel and involves formation of a continent catheterisable stoma connected to the caecum, through which enemas are flushed to aid evacuation. We present the first report of this procedure in an Irish setting.

Methods: We reviewed two patients who underwent an ACE procedure in Beaumont Hospital with regard to underlying disease, indication, procedure performed, outcome and complications.

Results: Both patients were male and had a primary diagnosis of spina bifida. Complete faecal incontinence was present in both and was complicated by slow transit constipation in one case. The patients were independently mobile and living and working in the community. In both cases a continent colonic conduit was formed from transverse colon and there were no post-operative complications. At follow-up of three years, both patients were continent rectally and one was continent at the stoma site. The other patient had minor leakage of mucus per stoma. Stoma revision was performed in one case due to prolapse. Discussion: This is the first report of ACE procedures in Ireland. Careful patient selection is critical, however good outcome can be achieved in motivated patients.