The button cecostomy for management of fecal incontinence

The antegrade continence enema (ACE), administered through a continent cutaneous appendicocecostomy, has been used to successfully achieve reliable evacuation and fecal continence in patients with myelomeningocele. However, as originally described, it is not suitable in patients without an appendix or those requiring urologic reconstruction with appendix. We report the use of a standard gastrostomy button in the cecum to create a continent cecostomy in five patients with fecal incontinence. Four underwent simultaneous urologic reconstruction, including two artificial urinary sphincter (AUS) implantations. At a mean of 28 months' follow-up, all five patients are continent of stool. One ACE button has been converted to an ileal Malone cecostomy at the patient's request. Complications included one appendiceal phlegmon requiring exploration and three superficial wound infections, one at a cecostomy site, responsive to antibiotics and local care. There were no AUS infections. The button cecostomy is an effective alternative to standard ACE procedures. It is particularly useful in those who require creation of an appendicovesicostomy for attainment of urinary continence.