by EBSCO Medical Review Board
(Malone Procedure; Antegrade Colonic Enema Procedure)


An appendicostomy makes a path from the belly button to the large intestine. The path is created using the appendix.

The Appendix Can Be Used to Deliver Enemas
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Reasons for Procedure

Enemas are normally given through the rectum. This surgery is done to make it easier to give an enema to a child. Enemas are fluids placed into the large intestine. The fluids help clean out the intestines when there is a problem. They may be needed in children with:

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Leaking
  • The need for repeat surgery

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies your child may have
  • Current medicines, herbs, and supplements that your child takes and whether they need to be stopped before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before


General anesthesia is used. Your child will be asleep.

Description of the Procedure

A small cut will be made just below the belly button. The tip of the appendix will 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 to 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 stay outside of the belly button. The tube will be taped into place. It will stay in place for 2 to 4 weeks.

How Long Will It Take?

About 2 hours

Will It Hurt?

Pain is common in the first few days. Medicine and home care can help.

Average Hospital Stay

The usual length of stay is 1 to 5 days. If your child has any problems, they may need to stay longer.

Post-procedure Care

At the Care Center

The staff will:

  • Give your child pain medicine
  • Teach you and your child how to care for the tube and give enemas
At Home

It will take 4 to 6 weeks for the site to fully heal. Physical activity will need to be limited during recovery. You may need to delay your child's return to normal activities.

Call Your Child's Doctor

Call the doctor if your child is not getting better or has:

  • Signs of infection, such as fever or chills
  • Redness, swelling, bleeding, or discharge from the incision
  • Pain that cannot be controlled with medicine
  • Trouble using the tube
  • The tube falls out before your child has healed

If you think you have an emergency, call for medical help 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: Accessed December 2, 2020.

Levitt MA, Soffer SZ, Péan A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg. 1997;32(11):1630-1633.

Management of constipation in children. EBSCO DynaMed website. Available at: Accessed December 2, 2020.

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.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 09/2020
  • Update Date: 04/16/2021