Malone antegrade continence enema

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The vermiform appendix is typically used in the Malone antegrade continence enema.

A Malone antegrade continence enema, also known as Malone procedure and by the abbreviation MACE, is a surgical procedure used to create a continent pathway proximal to the anus that facilitates fecal evacuation using enemas.

Description of procedure[edit]

The operation involves connecting the appendix to the abdominal wall and fashioning a valve mechanism that allows catheterization of the appendix, but avoids leakage of stool through it. If the appendix was previously removed or is unusable, a neoappendix can be created with a cecal flap.[1]


It is done to treat fecal incontinence unresponsive to treatment with medications. It is frequently done with a procedure (Mitrofanoff procedure) to treat urinary incontinence as the two often co-exist,[2] such as in spina bifida.

Surgical alternative[edit]

A percutaneous cecostomy tube[3] is an alternative to a MACE. It involves the surgical insertion of a catheter into the cecum for the same goal (of performing enemas). Percutaneous cecostomy procedures, like MACEs, have been performed laparoscopically.


It is named after the surgeon (Patrick Malone) who popularized it.[4]

Malone described it as an antegrade continence enema procedure.[4]

See also[edit]


  1. ^ Weiser AC, Stock JA, Hanna MK (June 2003). "Modified cecal flap neoappendix for the Malone antegrade continence enema procedure: a novel technique". J. Urol. 169 (6): 2321–4. PMID 12771790. doi:10.1097/01.ju.0000067286.80366.42. 
  2. ^ Teichman JM, Rogenes VJ, Barber DB (1997). "The utility of the Malone antegrade continence enema for urologists". Tech Urol. 3 (1): 30–3. PMID 9170222. 
  3. ^ What is a Cecostomy Catheter? URL: Accessed on: August 9, 2008.
  4. ^ a b Roberts JP, Moon S, Malone PS (March 1995). "Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure". Br J Urol. 75 (3): 386–9. PMID 7735806. doi:10.1111/j.1464-410X.1995.tb07354.x. 

External links[edit]