Pediatric Chronic Constipation

A Malone appendicostomy (MACE) is a procedure where a surgeon connects the appendix to the abdomen, making a pathway from the belly button to the colon using laparoscopic techniques. This pathway works as a valve where a catheter is inserted. A special solution is administered through the catheter to clean out your child’s colon each day. No artificial implants or devices are used because the valve has been created with your child’s own tissue. Following a MACE, your child will spend about two days in the hospital and require follow-up visits with your surgeon at one month to ensure they are healing properly.

A colon resection may be performed to remove diseased areas of the bowel that may be causing your child’s chronic constipation. This is only necessary in very rare cases unresponsive to medical treatments. This may include any area of the large intestine or rectum. The type of resection your child may need will depend on the severity of their specific condition. The surgery is performed using non-invasive techniques and is guided by the motility evaluation which maps which parts of the colon are working. Your child will typically spend one week in the hospital following a bowel resection and require a follow-up visit at one month to ensure that your child has healed properly and to check for any complications.

If your child has had a MACE procedure, a catheter will remain in place for one month. To keep the opening from closing once the catheter is removed, a type of plug called an ACE stopper will be put in its place for six months. The plug will be removed once daily to irrigate and flush the colon with a special solution.

View our videos featuring MACE recovery tips.

Your child’s medical team will give you detailed instructions on how to care for your child’s Malone surgery site once you are home. Keep in mind that drainage is normal and may resemble a clear to light yellow color. You will need to administer enema fluid daily through the catheter to keep the colon flushed and clean. For the first month, you should keep the Malone tube secured to your child’s abdomen (with clear tape dressing) without completely covering the opening. It is safe to shower and bathe after surgery. Make sure to clean around the tube insertion with soap and water and then pat dry.

You should call your child’s provider if you notice the following:

• Abdominal swelling or pain during or after flushing the colon
• Fever
• If the area or stitches holding the catheter in place become red and irritated
• The tube falls out prior to your child’s follow-up visit

After a colon resection, your child will be encouraged to get out of bed and walk as soon as possible. Doing so helps speed up recovery time. Your child may also receive medication for pain management.

Once you return home, make sure to follow your doctor's instructions regarding bathing and dressing changes. Keep an eye on the incision site for signs of infection, such as redness, swelling or drainage. It's normal to see some blood in the stool or diaper following surgery, but contact your doctor if you notice any excessive bleeding.

It will take some time for your child’s bowel movements to return to normal after surgery, and it's important to follow a healthy diet with enough fluids and fiber. Your doctor can provide specific guidance on your child's dietary needs during recovery.