Malone Antegrade Continent Enema: An Alternative to Resection in Severe Defecation Disorders

Abstract

Malone antegrade continent enema is a reasonable option for the treatment of select patients with severe defecation disorders. Good functional patient self-reported outcome was achieved by 78 percent of patients. The social inconvenience of stoma leakage is avoided with appropriate surgical technique. Malone antegrade continent enema is one option that provides a less invasive surgical alternative than colectomy or ileostomy for severe defecation disorders.

Successful pregnancy and delivery following a Malone antegrade continence enema procedure

“…The Malone antegrade colonic enema (MACE) was introduced in 1990 for the treatment of faecal incontinence of neurological origin or those with anorectal abnormalities, perineal trauma or repeated pelvic surgery [3] and was soon used to treat chronic constipation in the same groups with equally impressive results [4]. More recently, the MACE procedure has been used successfully to treat idiopathic constipation [5].…”

“…The stoma has traditionally been located in the right iliac fossa [3], but siting it in the umbilical skin fold gives a superior cosmetic result which is welcomed by the young female patients in whom this is performed for idiopathic constipation [5] (Fig. 2a, b).…”

“…The Malone antegrade colonic enema (MACE) procedure was introduced in 1990 as a treatment for faecal incontinence in neurological/spinal cord disorders [3] and the same technique soon found popularity treating chronic constipation in the same cohort of patients [4]. An increasing number of otherwise healthy patients with idiopathic or slow transit constipation have now also been successfully been treated by a MACE procedure [5,6]. Reports of the long-term outcomes of the continent stoma are scarce and do not discuss the impact of pregnancy on MACE function [7].…”

Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up

“…The ACE procedure, first described by Malone et al, is a reasonable option for the treatment of select patients with severe defecation disorders including refractory constipation. It provides a less invasive surgical alternative than colectomy or ileostomy with lower risk of major complications [23]. However, surgical Malone procedures like appendicostomy or caecostomy require an open operation with risk of complications like stoma stenosis, wound problems and mucous or faecal soiling [24].…”

Malone appendicostomy: an unexpected complication

“…It permits the administration of antegrade colonic enemas (ACE) for colonic evacuation, improving quality of life [5,6] and bowel function [7][8][9][10]. In children, the most frequent indications for MA are incontinence after reconstruction of congenital anorectal malformation or neurological disorders such as spina bifida.…”