Appendicitis in a Spontaneously Closed Malone Appendicostomy: A Case Report and Review of the Literature

The Malone appendicostomy is an established treatment for refractory constipation in children with neurogenic bowel dysfunction or anorectal malformation.Once the conduit is no longer required, there is no published guidance on managing the redundant tract, and practice remains varied.Appendicitis arising within a spontaneously closed appendicostomy has been reported only three times.An 18-year-old patient with spina bifida, neurogenic bowel dysfunction, and a ventriculoperitoneal shunt presented with right iliac fossa pain, fever, and purulent discharge from a Malone appendicostomy created at eight years of age and unused for five years.Inflammatory markers were only modestly elevated, without leukocytosis.Computed tomography (CT) demonstrated an inflamed appendicostomy with surrounding fat stranding and subcutaneous collections, without a radiopaque fecolith.Open appendicectomy was performed through the appendicostomy site, and histopathology confirmed suppurative appendicitis with a 3 mm intraluminal fecolith.Three published cases of appendicitis following spontaneous closure and one of luminal obstruction within an actively used conduit were reviewed alongside the present case.Spontaneous closure of a Malone appendicostomy may leave a blind-ending appendix susceptible to luminal obstruction, and a normal white cell count and the absence of a radiopaque fecolith, both of which fall within the limits of routine investigation, should not exclude the diagnosis.As the first generation of appendicostomy recipients reaches adult life, this presentation may be encountered more often in adult surgical practice.