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(Malone Procedure; Antegrade Colonic Enema Procedure)


An appendicostomy is the creation of a pathway from your belly button to the large intestine. The pathway is created using your own body tissue, the appendix. Using your own body tissue instead of an artificial tube will decrease the chance of irritation.

The Appendix Can Be Used to Deliver Enemas

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Reasons for Procedure    TOP

An appendicostomy is done to help deliver enemas more easily. Enemas are fluids that are placed into the large intestines to soften stool and relieve constipation. The fluids help clean out the intestines when there is a problem with the intestines or stool. Enemas may be needed in children with spina bifida, spinal injuries, Hirschprung’s disease, or constipation not relieved by medical care.

Enemas are normally given through the rectum. This can make it difficult for people to deliver the enemas to themselves. For older children, it can be difficult to have rectal enemas delivered by their parents. An appendicostomy can allow more independence for these children.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Excess bleeding
  • Adverse reaction to anesthesia such as lightheadedness, low blood pressure, or wheezing
  • Infection
  • Leakage of tube or appendix
  • Narrowed or blocked tube that requires a second surgery to fix it

Talk to your doctor about these risks before the procedure.

What to Expect    TOP

Prior to Procedure

Your doctor will need to make sure that enemas are effective for your condition. You will also need to show good fecal control with enemas. Good control is staying clean for at least 24 hours after emptying your bowels.

You may need to stop taking some medications up to one week before the procedure.


General anesthesia is used. You will be asleep during the procedure.

Description of the Procedure    TOP

A small cut will be made just below the belly button. The tip of the appendix will also be opened. The opened end will then be attached to an opening in the belly button. If the appendix has been removed previously, a new one will be created from the large intestine. A valve will then be placed at this connection. The valve allows the enema to flow in but keeps fluids from leaking out.

A tube will be passed through the belly button and valve. The tip of the tube will stay in the appendix. The end of the tube will remain outside of the belly button. The tube will be taped into place. This tube will stay in place for 2-4 weeks after the surgery until the area heals.

How Long Will It Take?    TOP

About 2 hours

Will It Hurt?    TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay    TOP

The length of stay may be 1-5 days. If you have any problems, you may need to stay longer.

Post-procedure Care    TOP

At the Care Center

You will be shown how to care for your tube and deliver enemas.

Enema will be given within 24 hours of the first meal. Although, you may need to wait longer if a new appendix was created.

At Home

Activities will be restricted, including swimming. Some sports or activities can be resumed once recovery is complete. Cleaning the incision site as advised will help prevent infection. Try to keep the area clean and dry. Follow special instructions from the healthcare team on how to care for the tube.

Call Your Doctor    TOP

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Have trouble using the tube
  • Tube falls out before healing time is done
  • Pain that is not controlled with medication
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Abdominal pain
  • Trouble passing enema through tube

If you think you have an emergency, call for emergency medical services right away.


American Society of Colon and Rectal Surgeons
Healthy Children—American Academy of Pediatrics


Canadian Association of Gastroenterology
Sick Kids—The Hospital for Sick Children


Appendicostomy (Malone procedure). Cincinnati Children’s website. Available at:
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Accessed October 21, 2012.
Appendicostomy. Intermountain Healthcare website. Available at: Accessed October 21, 2012.
Levitt MA, Soffer SZ, Péan A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg. 1997;32(11):1630-1633.
Taiwo A, Rangel SJ, Bischoff A, Peña A, Levitt MA. Laparoscopic-assisted Malone appendicostomy in the management of fecal incontinence in children. J Laparoendosc Adv Surg Tech A. 2011;21(5):455-459.
Last reviewed June 2016 by Daus Mahnke, MD
Last Updated: 6/24/2013

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