[ACE procedure for life long constipation in adult]

Area of Science:

• Gastroenterology and Colorectal Surgery

Background:

• Chronic constipation significantly impacts quality of life, often necessitating advanced treatment options.
• The antegrade continent enema (ACE) operation, typically performed in children, is rarely applied to adults with severe, refractory constipation.

Observation:

• A 46-year-old female with lifelong severe constipation, unresponsive to laxatives, underwent an ACE operation.
• Post-operatively, the patient experienced improved bowel movement frequency and predictability, though initial quality of life assessments showed no change.
• A mild stenosis at the appendico-caecal junction required radiological balloon dilatation for optimal function.

Findings:

• The ACE operation, or Malon Operation, in this adult patient demonstrated improved predictability of bowel movements.
• Despite improved predictability, standard quality of life instruments did not register a significant improvement at three months post-surgery.

Implications:

• The Malon Operation (ACE) presents a viable, non-resective surgical approach for select adult patients suffering from severe, chronic constipation.
• Further research is warranted to fully elucidate the long-term quality of life benefits and patient selection criteria for ACE in adults.