Jeffrey Avansino

If patient with Malone is not doing well and flushes are not working or they are getting significant symptoms like nausea, you must do a contrast study through the Malone to check for reflux into the terminal ileum.

Wrapping technique depends on mesentery appearance: broad-based mesentery allows making a window and wrapping through it; adherent single-vessel mesentery allows laying down and wrapping cecum around appendix.

For leaking Malones, first ensure patient is cleaning themselves out with effective enemas and consider thickening stool with water-soluble fiber before attempting surgical plication.

If patient is not doing well with flushes or getting significant symptoms like nausea, a contrast study through the Malone should be done to check for reflux into the terminal ileum.

For patients who cannot catheterize their Malone after surgery, a Malone plug can be used for a few months with gradual tapering of the time the tract is allowed without the plug.

Using a 10 French coude catheter as a bougie during plication and checking passage afterward usually prevents single offending stitches from causing obstruction.