The Use of a Low Profile Gastrostomy Device to Enhance Malone Antegrade Continence Enema (MACE) Irrigation

Statement of Clinical Problem:    A Malone Antegrade Continence Enema (MACE) is a type of surgery designed for the child with chronic bowel problems such as constipation or fecal incontinence.  A tract is created into the large intestine.  The goal is to allow for daily irrigation of the colon to maintain continence.  D is a 7 year old male with a history of Down syndrome and Hirschsprung's disease with chronic fecal incontinence.

Description of Past Management:    Attempts were made to catheterize the MACE channel but due to stenosis and pain the daily flushes became challenging.  D attends school and struggles socially due to leakage of stool and odor.  His mother was called to the school daily due to episodes of fecal incontinence.  This caused D to miss valuable classroom and social time with his peers.        

Current Clinical Approach:  D was brought to the clinic and the MACE tract was measured.  A low profile gastrostomy button was placed in the MACE channel.  This allowed mom to attach an extension tube to the button to administer the daily flush without pain or difficulty. 

Patient Outcomes:   The use of the button to administer a daily flush has been effective in keeping D continent of stool.  He is no longer experiencing pain and anxiety during his daily irrigation through the button.

Conclusion:  Irrigation using a low profile button has improved the quality of life for D and his family.   D has remained continent and odor free.  He is thriving in school and no longer feels isolated from his friends.