A Malone antegrade continence enema is a surgical procedure where the vermiform appendix or ‘neoappendix’ is used to create a small stoma at the abdominal wall allowing antegrade enemas to be administered to empty the colon and rectum. This procedure is particularly important in children and adolescents for the management of fecal incontinence or constipation where standard medical therapies have failed. This is often performed in conjunction with the Mitrofanoff procedure to help with urinary incontinence.
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Indications
intractable fecal incontinence
severe constipation
Technique
In this operation, the appendix is isolated and a stoma is created at the umbilicus or in the right lower quadrant. A catheter is inserted and is irrigated to help with fecal incontinence or constipation 1.
Complications
hemorrhage
stomal stenosis
stomal leakage
adhesion obstruction
stomal prolapse
wound infection
Outcomes
The procedure has reported success rates of up to 90% for neurogenic fecal incontinence 3-5.
History and etymology
Malone et al first described this technique in 1990 for the management of children with intractable fecal incontinence 1. This technique was described based on the principles of antegrade colonic washout and the Mitrofanoff procedure. The technique was later revised and the indication expanded for the management of patients with severe constipation 2,3.
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