Background Roughly 1500 children are born with spina bifida (SB) each year within the United States. Of that 1500 about 78% of them have fecal incontinence attributed to neurogenic bowel dysfunction (NBD). The development of fecal incontinence and chronic constipation have been shown to be caused by the loss of motor and sensory function to the gastrointestinal tract. NBD has been shown to be a major problem for children and adults with SB, significantly decreasing quality of life. The treatment of NBD is multifactorial and is aimed to provide appropriately timed defecation. The treatment for NBD should start conservatively with a bowel regimen. Once conservative measures are exhausted there are surgical options available including the Malone antegrade continence enema (MACE) procedure or cecostomy. The MACE procedure has several indications including chronic constipation, NBD, anorectal abnormalities, and Hirschsprung disease. The MACE procedure involves dividing the appendix from the cecum, mobilizing it, bringing it most commonly to the umbilicus, leaving two centimeters of intra-abdominal stoma followed by division of the appendicular artery, and fixation of the stoma to the abdominal wall. Common complications of the MACE procedure include stoma stenosis, incontinence, mucosal prolapse, small bowel obstruction, and need for revision. Case Presentation This report describes a 31-year-old male who presented to the emergency department with symptoms of peritonitis. Patient has a significant history of SB with NBD and neurogenic bladder, as well as a significant surgical history of the MACE procedure as a child. On presentation, the patient had a computed tomography that was highly suggestive of small bowel obstruction, which promoted urgent surgical intervention. Diagnostic laparoscopy was negative, except for purulent fluid found within the abdominal cavity. Later additional history taking and clinical correlation revealed the patient likely attempted a self-enema while intoxicated, leading to the creation of a false lumen and the subsequent development of peritonitis. Discussion This case report is the first reported adult case of incidental false lumen creation causing peritonitis following the MACE procedure. There is no documented literature showing what the next steps should be in the adult population following perforation of the MACE procedure. This case report is aimed to present a rare and unique complication of the MACE procedure in the adult population. Additionally, we aim to prompt the need for further research of using known alternates to the MACE procedure in the adult population. This report also shows the need for continued life-long follow-up in these patients.