(Malone Procedure; Antegrade Colonic Enema Procedure)
An appendicostomy makes a path from your belly button to the large intestine. The path is created using your appendix. This will lower the chances of irritation.
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Reasons for Procedure
An appendicostomy makes it easy to give an enema. Enemas are fluids placed into the large intestine. They soften stool to ease constipation. The fluids help clean out the intestines when there is a problem. They may be needed in children with:
Enemas are normally given through the rectum. This can make it harder to deliver the enema on your own. For older children, it can be harder for the rectal enemas delivered by their parents. An appendicostomy will allow for your child to care for themselves.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems such as:
- Reaction to anesthesia
- The tube or appendix leaks
- Problems with the tube leading to another surgery
What to Expect
Prior to Procedure
Your doctor will need to make sure that enemas will help you. You will also need to show good stool control. Good control is staying clean for at least 24 hours after emptying your bowels.
You may need to stop taking some medicines up to 1 week in advance.
General anesthesia —you will be asleep
Description of the Procedure
A small cut will be made just below the belly button. The tip of the appendix will also be opened. The opened end will attach to an opening in the belly button. If the appendix was removed, a new one will be made from the large intestine. A valve will then be placed. The valve allows the enema flow one way.
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.
How Long Will It Take?
About 2 hours
Will It Hurt?
Anesthesia will prevent pain during surgery. Medicines will ease pain afterwards.
Average Hospital Stay
The length of stay may be 1-5 days. If you have any problems, you may need to stay longer.
At the Care Center
You will be shown how to care for your tube and give enemas.
Enema will be given within 24 hours of the first meal. You may need to wait longer if a new appendix was made.
You won't be able to do certain activities such as swimming. You may be able to start them again once you are better. Clean the wound as advised to prevent infection. Your healthcare team will teach you how to care for the tube.
Call Your Doctor
Call your doctor if any of these occur:
- Have trouble using the tube
- Tube falls out before you're healed
- Pain that you can't control with the medicines you were given
- Signs of infection such as fever or chills
- Redness, swelling, pain, bleeding, or any pus from the wound
- Belly 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: https://www.cincinnatichildrens.org/service/c/colorectal/treatments/appendicostomy. Accessed August 13, 2018.
Appendicostomy. Intermountain Primary Children's Hospital website. Available at: https://intermountainhealthcare.org/ext/Dcmnt?ncid=521117329. Updated June 2018. Accessed August 13, 2018.
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 May 2018 by EBSCO Medical Review Board Daus Mahnke, MD Last Updated: 8/13/2018