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Appendicostomy

(Malone Procedure; Antegrade Colonic Enema Procedure)

Definition

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. There is also no external sign of the new pathway.
Appendix
Appendix
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Reasons for Procedure

An appendicostomy is done to help deliver enemas ore 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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will talk to you about problems that could occur, like:
  • Excess bleeding
  • Adverse reaction to anesthesia such as light-headedness, 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

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 medicines up to one week before the procedure.

Anesthesia

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

Description of the Procedure

A small cut will be made just below the bellybutton. 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 bellybutton. 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?

About 2 hours

Will It Hurt?

Anesthesia will block pain during surgery. You may have some discomfort after the surgery. You doctor will offer medication to help.

Average Hospital Stay

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

Post-procedure Care

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
When you return home, take these steps:
  • Follow your doctor’s instructions on cleaning the incision site. Leave the incision open to air.
  • Some leakage is normal. Try to keep area dry.
  • Avoid vigorous sports or activity until you have recovered after surgery
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Once recovered there should be no activity restrictions including swimming.
  • Be sure to follow your doctor’s instructions.
Follow instruction to care for your tube. General steps include:
  • Leave the tube in place after surgery until your doctor lets you know it is okay to remove it.
  • Tape the tube in place while you heal. This will keep the tube in ideal position.
  • Follow directions to place and use the tube once you have healed.

Call Your Doctor

Call your doctor if any of these occurs:
  • 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 have an emergency, call for medical help right away.

RESOURCES

American Society of Colon and Rectal Surgeons http://www.fascrs.org

American Academy of Pediatrics http://www.healthychildren.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology http://www.cag-acg.org/

Sick Kids http://www.sickkids.ca/

References

Appendicostomy (Malone Procedure). Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/service/c/colorectal/treatments/appendicostomy/ . Accessed October 21, 2012.

Appendicostomy. Intermountain Healthcare website. Available at: https://intermountainhealthcare.org/ext/Dcmnt?ncid=521117329 . Accessed October 21, 2012.

Levitt MA, Soffer SZ, Péan A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg . 1997 Nov;32(11):1630-3.

Taiwo A. Lawal, Shawn J. Rangel, Andrea Bischoff, Alberto Peña, and Marc A. Levitt. Journal of Laparoendoscopic & Advanced Surgical Techniques. June 2011, 21(5): 455-459.

Revision Information

  • Reviewer: Michael Woods, MD
  • Review Date: 06/2014
  • Update Date: 06/24/2013

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