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Malone Appendicostomy: Relief from Chronic Constipation

A Malone appendicostomy (MACE) is a surgery that makes a pathway from the belly button to the colon. It is used as a treatment option for children with chronic constipation, with or without fecal soiling. Chronic constipation can be caused by several different diagnoses. Some of those include anorectal malformation, Hirschprung disease, colonic dysmotility and spinal anomalies.

During the Malone procedure, the surgeon connects part of the appendix to the abdomen or belly button, creating a one way valve between the skin and colon. This valve allows a catheter to go in but no fluids can come out. It is made with your child’s natural tissue, so no artificial device is used. Each day you your child’s colon can be cleaned out when they instill a special solution through the catheter.

Our body’s natural response to an artificial opening in the skin is to heal over the site. In order to keep the skin of your child’s abdomen or belly button open after surgery, a catheter will remain in place for one month. After the catheter is removed, an ACE stopper or “plug” is kept in the opening for six months. This is similar to when someone gets his or her ears pierced, an earring remains in the opening to prevent the hole from closing. Your child will take this plug out once a day when it is time to do their flush. When the flush is preformed, a special catheter called a coude, will be used. The solution used in the flush will be based on your individual child.

What to expect after surgery?

It is very uncommon for Malone sites to become infected, however it is very common for them to have drainage. This drainage is typically clear or light yellow and it may have a smell or odor. Children can return to normal activities, like gym and sports, one week after surgery. Enema fluid will need to be flushed through the catheter tube once your child is eating normally. This flush will be done by the care team during the hospital stay; once discharged, you will be performing the daily flushes through the catheter. At the post-operative appointment, the healthcare team will teach you how to insert the coude catheter in the Malone site as how to place the silicon ACE stopper or “plug.” This plug keeps the skin from becoming stenotic, or narrowed.

How to care for the Malone during the first month after surgery?

Keep the Malone tube secured to your child’s abdomen with a clear tape dressing until the follow up appointment. You may replace this clear dressing with tape as needed, but do not completely cover the site. The stitches may fall out before the post-operative follow-up appointment. If this happens, be sure to secure the small tube with tape or another clear dressing. Do not cover the belly button. It is not uncommon for the stitch holding the catheter in place or skin under the tape become irritated or red. If this happens, notify your child’s provider. Your child may shower, swim and take tub baths after surgery. Clean around the tube insertion (belly button) daily with soap and water, patting it dry and use a Q-tip to clean any dried drainage that settles in the belly button. You may also use ‘No rinse foam cleanser’ to clean the insertion site.

When should you call your child’s provider?

  • The small tube falls out – before you child’s post operative visit
  • There is redness or any hard area around the site
  • Fever over 101 degrees
  • Abdominal swelling during or after the flush

For more information about Nationwide Children’s Hospital’s Center for Colorectal and Pelvic Reconstruction, click here.

Meghan Fisher, BSN, RN
Meghan Fisher, BSN, RN, is the Clinical Leader of Education at the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital. She received her nursing degree from Capital University. Meghan joined Nationwide Children's Hospital as a Pulmonary ICU PCA while she completed nursing school. After graduation, she began work as a nurse on the Gastroenterology, Endocrinology, Genetics, and Rheumatology floor. Meghan joined the CCPR team in 2015 as a nurse clinician and has a special interest in teaching others about these complex colorectal diagnoses. She has educated domestically and internationally on colorectal diagnoses and their care. Meghan is a member of the American Academy of Ambulatory Care Nursing.
Laura Brubaker, BSN, RN
Laura Brubaker, BSN, RN serves as a Nurse Clinician for the Center for Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children's Hospital. She received her Bachelor of Science in Nursing from Mount Vernon Nazarene University. Laura joined Nationwide Children's Hospital as a nurse intern on the Gastroenterology, Renal, Endocrinology, Genetics, and Rheumatology floor, where she transitioned to a patient care assistant and later a nurse. She was a travel nurse, gaining experience and new perspectives from various hospitals. She has lectured nationally and internationally at Pediatric Colorectal and Pelvic Reconstruction Conferences. She is also a member of the American Academy of Ambulatory Care Nursing.
Onnalisa Nash, CPNP-PC
Onnalisa Nash, CPNP-PC, serves as an Advance Practice Nurse for Colorectal and Pelvic Reconstruction (CCPR) at Nationwide Children's Hospital. She completed her Masters of Science in Nursing as a Pediatric Nurse Practitioner at The Ohio State University in Columbus, Ohio. Her previous experience includes working in the neonatal intensive care unit and as a wound, ostomy, and continence nurse. Onnalisa joined the CCPR team in May 2014. She is a Certified Pediatric Nurse Practitioner specializing in pediatric colorectal and pelvic reconstruction issues such as Anorectal Malformations, Hirschsprung Disease and other disorders of the bowel. Onnalisa supports the CCPR as a Coordinator for the Advance Practice Nursing Team specializing in Education and Onboarding. She has lectured nationally and internationally at Pediatric Colorectal and Pelvic Reconstruction Conferences and is active in the American Pediatric Surgical Nurses Association.

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