Antegrade Continence Enema (ACE) Procedure

What is an antegrade continence enema (Malone procedure)?

An antegrade continence enema (ACE), also called the Malone procedure, is an alternative way to give an enema. An enema is typically given by inserting a tube into the rectum and administering a solution that helps empty the colon. The ACE is an option for children who need long-term enema therapy, but who do not want to have daily enemas given by rectum.

The ACE allows children to give their own enemas through a tube that passes through the abdominal wall. This increases their independence and improves their quality of life. The ACE procedure may be done as an outpatient procedure or may require a short stay in the hospital.

The ACE procedure is a surgical procedure that uses your child’s appendix or small piece of intestine (cecum) to create a tube through which an enema is given. This small tube is used to make a tunnel from the outside of your child’s abdomen to the colon. This small, pencil-sized opening on the abdomen is called a stoma.

The stoma is positioned either on the lower right side of the belly or at the belly button. A valve is created in the stoma so that stool will not leak out of the opening.

The enema is given by way of a small catheter that is passed through the stoma and into the colon. The enema solution flushes out the colon in the direction that the waste travels. Salt water solutions or other specialized enema solutions can be given through the small catheter. This is a much easier way to give an enema because the child can sit on the toilet as the enema or “flush” is given. The child can expect to start having a bowel movement 10 to 20 minutes after the solution is given.

The ACE procedure can be done using a laparoscopic method, which is less painful and less invasive for the child – it also allows for quicker recovery time. Laparoscopic surgery entails small incisions being made on the abdomen and the use of a long telescope-like instrument.

Why choose Children’s Hospital Colorado for an ACE procedure?

Children's Colorado only cares for kids - making us experts in caring for kids of all ages. We offer the only pediatric colorectal program in the western United States dedicated to treating children who need an ACE.

What are the signs that my child needs an ACE?

Your child’s doctor and/or pediatric surgeon will determine if your child needs long-term enemas in order to have bowel movements on a regular basis and if the ACE procedure is the right treatment.

Your surgeon will discuss the best options available for your child and give you all the information needed to make the right decision for your family. If it is determined that an ACE is the best option, your care team at Children’s Colorado will give you detailed information on what to expect during the hospital stay, as well as how to care for your child after the surgery.