Colorectal

Malone Appendicostomy

A Malone appendicostomy is a surgery which creates a channel from the belly button to the right side of the colon using the appendix. This channel also has a one-way valve that will allow a catheter to go in but no fluids or leakage to come out. By using the patient’s own appendix we can avoid the use of artificial devices which can be seen and can cause irritation. After the creation of the appendicostomy, since the opening is hidden in the belly button, no one except for the patient, family and doctor know it is there. The child can participate in all activities including swimming.

At the end of the operation there will be a device called a Mini Ace that is left in the channel coming from the belly button. This device has an extension tube that is attached each time you want to give your child’s flush. On rare occasions we may use a different tube called a Foley catheter.

View Malone appendicostomy handout (PDF)

About the Mini Ace

What are the key things to know about a Mini Ace?

The Mini Ace needs to stay in place for six months after surgery to prevent the channel from closing.
Keep the site clean using mild soap and water to clean around the Mini Ace site at least once a day.
Your child can shower, bathe and swim normally with the Mini Ace in place as soon as you return home from the hospital.
One week after surgery, your child can participate in normal physical activities with the Mini Ace in place.
You will be given a spare Mini Ace when you leave the hospital. Keep this in a safe place in the event your child loses their Mini Ace!
If the Mini Ace falls out, do NOT replace it.
- Contact us immediately so we can help to arrange for a medical professional to insert your spare Mini Ace and confirm correct placement!

When should I contact the Children's National colorectal team?

Performing a Malone Flush

What supplies are needed for a malone flush?

How can I set up to do a malone flush?

Gather all supplies.
Prepare your child’s flush by measuring each ingredient and mixing them in a common container.

If using a gravity bag:

Make sure the roller-clamp is down on the gravity bag so the fluid does not leak out of the bag.
Pour the flush into the gravity feeding bag.
Unroll the clamp slowly to allow the fluid to prime the tubing.
Once the fluid is at the end of the tip, roll the clamp down again.

If using a 60 ml Cath-Tip syringe:

Draw up 60 ml of fluid at one time.

How do I administer a flush?

Have your child sit on the toilet.
Attach the extension tubing to the Mini Ace.

If using a gravity bag:

Attach the end of the gravity bag to the extension tubing on the Mini Ace.
Unroll the clamp to allow the flush to run through the tubing over 5-10 minutes.

You can control the speed of the flush by rolling the clamp down if your child experiences cramping or discomfort.

After the flush has completed you may disconnect the extension tubing to the Mini Ace.
Allow your child to sit on the toilet for their instructed period of time.
Clean the gravity bag tap water and allow it to air dry before putting it away.

If using a 60 ml Cath-Tip syringe:

Attach the 60 ml Cath-Tip syringe to the extension tubing on the Mini Ace.
Slowly and gently push the fluid out of the syringe and into the Mini Ace.
Continue to refill the syringe and administer the flush until your complete dose has been given.

It should take a total of 5-10 minutes for the entire flush to go in.

After the entire flush has been administered, disconnect the extension tubing from the Mini Ace.
Allow your child to sit on the toilet for their instructed period of time.

What should I remember when doing a flush?

Caring for Your MiniAce Balloon Device

Antegrade Malone Flush Instructions

How to Care for Your Child's MiniACE Balloon Device

The goal of this video is to educate and empower you to independently care for your child’s MiniACE device at home. In this video we will review both routine care measures for your child’s device as well as how to exchange the device at home if instructed to do so by your child’s care team.

How to Give Your Child an Antegrade Malone Flush Using a Coude Catheter

The goal of the Malone flush is to mechanically clean the colon of stool every 24 hours and be free from accidents. In this video, we will walk through the steps to successfully perform an Antegrade Malone Flush using a Coude Catheter on your child.

How to Change Your Child's MiniACE Balloon Device

The goal of this video is to educate and empower you to independently care for your child’s MiniACE device at home. In this video we will review how to change your child’s MiniACE device. You should ONLY change your MiniACE device if you have been instructed to do so by your child’s medical team.

How to Give Your Child an Antegrade Malone Flush Using a MiniACE Balloon Device

How to Check Your Child's MiniACE Balloon Device

The goal of this video is to educate and empower you to independently care for your child’s MiniACE device at home. In this video we will review how to check the balloon on that device if you are told to do so by your child’s medical team.

Contact Information

If you have any questions about your child’s regimen, please email the Colorectal Clinical Team or contact us at 202-476-COLO (2656).

Email us Call 202-476-2656