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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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.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Excess bleedingAdverse reaction to anesthesia such as lightheadedness, low blood pressure, or wheezingInfectionLeakage of tube or appendixNarrowed or blocked tube that requires a second surgery to fix it
Talk to your doctor about these risks before the 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.
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.
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
The length of stay may be 1-5 days. If you have any problems, you may need to stay longer.
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.
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.
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 tubeTube falls out before healing time is donePain that is not controlled with medicationSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or any discharge from the incision siteAbdominal painTrouble passing enema through tube
If you think you have an emergency, call for emergency medical services right away.
Appendicostomy (Malone procedure). Cincinnati Children’s 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.
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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
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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