How is antegrade colonic enema (ACE) surgery performed?

In the surgery, a small passageway is created between the skin of the abdomen and the colon (large intestine). The passageway is made from the appendix (if the appendix has not been removed) or from a small piece of bowel. A section of small intestine is made into a conduit (tube) and is reimplanted into the large intestine. This conduit is brought to the surface of the skin via a small opening called a stoma.

In many cases, ACE surgery can be done using a laparoscopic method that is minimally invasive, so that the patient does not have to be cut open.

What happens after the surgery?

Following the surgery, a catheter (thin plastic tube) will be left in the stoma to keep it open. The catheter remains in place for one month after the surgery. During this time, the catheter should be flushed daily with tap water or a fluid determined by your doctor. Your doctor or nurse will instruct you regarding how to flush out your bowels at home.

Last reviewed by a Cleveland Clinic medical professional on 12/16/2017.


  • Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336:1217-1218.
  • Bruce RG, el-Galley RE, Wells J, et al. Antegrade continence enema for the treatment of fecal incontinence in adults: use of gastric tube for catheterizable access to the descending colon. J Urol 1999;161(6):1813–6.

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