Antigrade Colonic Enema (ACE) Information for patients Spinal Injuries
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This leaflet has been produced in support of the explanation and counselling provided by your urologist and nurse specialist. Who is an antigrade colonic enema (ACE) procedure recommended for? This operation is performed to manage severe constipation or bowel incontinence, which have not responded to other treatment. It is only suitable for you if you can use a toilet for bowel management. What is an ACE procedure? A catheterisation port (stoma) is created, using either your appendix or a small segment of bowel re-fashioned into a narrow tube. One end of the tube is implanted into the bowel wall at the start of the colon (large bowel), and the other end brought out onto the surface of the abdomen (stomach). Once fully healed, this stoma will appear as a small dimple on the abdomen. It should not leak between bowel washouts. You will not need to wear a colostomy appliance. How do I use the ACE stoma to manage my bowels? When you need to manage your bowels, you insert a catheter (we recommend the same catheters used for intermittent self catheterisation of the bladder) through the stoma. You then run water into your upper colon. This water washes the faeces from the rest of your colon and rectum out through your bottom. page 3 of 8
What needs to be done before I have the surgery? You will be admitted to the hospital before the operation for: Routine blood tests Antibiotic therapy Checking if you have MRSA or any other infection that may affect the success of the operation Treatment to protect your stomach from the effects of the surgery Treatment to protect you against thromboembolism (deep vein thrombosis / pulmonary embolism blood clots forming in your veins) as a result of the surgery Your bowel to be cleared out in preparation for surgery: Medicine, in the form of drinks, will evacuate the contents of your bowel. We will start you on a programme of special drinks at meal-times to give you some nourishment. A drip will be put up the evening before the operation to replace fluid lost with bowel preparation. Abdominal, including pubic, hair, may be shaved off. You will have nothing to eat or drink from 4.00am on the morning of the operation. Following surgery, you may require a bed in the Intensive Therapy Unit or High Dependency Unit. What does the surgery involve? The operation will be performed through an incision (cut) from the umbilicus (belly button) to the pubic bone. The catheterisation port is created by using your appendix or a piece of your bowel re-fashioned into a narrow tube. One end of this tube is implanted into the wall of the colon and the other end is brought out onto the surface of the page 4 of 8
abdomen, either through the belly button or through a small incision nearby. It does not stick out, but lies flush with the skin. What can I expect after I wake up? You will return from theatre with: A drip to keep you hydrated until you can drink freely (4-5 days later). A naso-gastric tube. This is fed through your nostril and down into your stomach. It enables secretions to be drained from your stomach to prevent vomiting until your gut starts working properly again, around 3-5 days later. Your wounds will be closed with a stitch (which dissolves on its own in time), or staples (which will be removed 10 days after your operation). You may have a drain, a thin polythene tube, draining into a plastic bag or bottle. This allows any excess fluid inside your abdomen to drain away. This is usually removed after 3-6 days. You may have a urethral catheter to drain your bladder. This is for convenience only and will be removed as soon as you are well enough to empty your bladder the way you normally do. A catheter will be placed into your catheterisation port (stoma). This stays in place for about 3 weeks, until you have healed inside. When you start to eat solid food again (several days after the operation) you will need to start washing out your bowel via this catheter. A nurse will show you how to do this. You can do your own daily washout as soon as you feel able. Nurses will supervise you until you feel confident to do it alone. page 5 of 8
When can I go home? About 7-10 days after your operation when you feel well, are eating and drinking, and you are confident with washing your bowel out: you will be referred to the district nurse for help and support at home. you will be supplied with equipment and instructions for bowel washout management, and advised on how to deal with any problems What happens next? You will be given a date to return to the ward for an overnight stay 3 weeks after the operation, when the stoma catheter will be removed. A nurse will supervise you passing a catheter into the stoma yourself, as you will then do this to perform your washouts. You will be seen in the outpatient clinic 6 weeks later for a progress check. page 6 of 8
Who should I speak to if I have any concerns? If you have any concerns, do not be afraid to seek advice from the Urology Nurse Specialists with Spinal Injuries or the staff at the Spinal Injuries Centre. Sister Paula Muter or Sister Marie Watson Urology Nurse Specialists 0114 271 5624 (Bleep 2494) 0114 226 6823 (Bleep 2882) Ward Osborn 2 0114 271 5628 / 29 Sister, Outpatient Department 0114 271 5677 The Princess Royal Spinal Injuries and Neurorehabilitation Centre Osborn Building Northern General Hospital Herries Road Sheffield S5 7AU 0114 271 5624 page 7 of 8
Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD8636-PIL3653 v2 Issue Date: June 2018. Review Date: June 2021