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Pediatric Surgery Care

Bby By Susheewa Wichaikull

Imperforate Anus ( Anorectal)In individuals with a normal anatomy, the large

intestine (colon) empties into a pouch-like portionof bowel (rectum). Through complex nerve andmuscle structures, the rectum releases stool throughth t f th b d the anus out of the body.

An imperforate anus is a malformation of the

Imperforate anusp

anorectal region that may occur in several forms.The rectum may end in a "blind pouch"--one that does not connect with the colon-- or it may have openings to the urethra, bladder, or vagina. A condition of stenosis, or narrowing of the anus, or an absence of the anus may also be present.

Surgical repair involves creating an opening for passage of stool. Complete absence of an anal opening requires emergency surgery for a newborn.

Treatment Surgery for a high-type and intermediatimperforate anus defect usually involves creation of a temporary opening of the large intestine (colon)onto the abdomen to allow passage of stool (this iscalled a colostomy). The baby is allowed to grow for several months before attempting a morecomplex anal repaircomplex anal repair.

Through an anal incision, the rectal pouch is pulleddown into place, and the anal opening is completed.The colostomy may be closed during this stage ormay be left in place for a few more months and closed at a later stage.

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The child may require several days in the hospital.Dilatation of the new anus (to improve muscle tone and prevent narrowing) will begin in the hospital andcontinue for some months. Stool softeners and ahigh-residue diet will need to continue throughoutchildhood.

อาการ

ไมถ่า่ยขีเ้ทา ทอ้งอดื ขาดน้ําการรักษา

High Type และ Intermediate ทาํผา่ตดั Colostomy เม่ือเดก็อาย ุประมาณ 1 ปี หรือนํ้ าหนกั 10 kg ทาํ Abdominperineal pull-

ThroughThrough

Low Type ทาํ Anoplasty

การพยาบาล ก่อนผา่ป้องกนัทอ้งอืด

หลงัผา่ตดัป้องกนัการตดิเชือ้ทีแ่ผล แช่กน้ บางใช ้Nss Providine เช็ด

The colon, or large intestine, is a muscular tubethat begins at the end of the small intestine andruns to the rectum. The colon absorbs water from liquid stool that is delivered to it from the small intestine.

Meckel Diverticuli

Diverticula are out-pouchings of the wall of the colon.They are thought to be the result of a diet low infiber. By the age of 60, over half of all Americanshave colonic diverticula.

In most cases diverticula go unnoticed However In most cases, diverticula go unnoticed. However, in a small percentage of patients, diverticula can cause problems. The most common problem is diverticulitis, which occurs when a small, hard piece of stool is trapped in the opening of the diverticula.This leads to inflammation and death of the segmentof colon containing the diverticula.

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Diverticula can also bleed and cause significant bloodloss from the gastrointestinal tract. Vessels overlying a diverticula are stretched until they break, causing bleeding into the colon. Blood is usually passed in the stool.

Treament of diverticulitis and diverticular bleeding involves surgical removal of the segment of colon containing the diverticula.

After the diseased area is removed, the healthyends of the colon are sewn back together. Occasionally, especially in cases of diverticulitis, where there is significant inflammation, a colostomyis performed.

Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) affects mainlypremature babies. It is the most common surgical emergency in newborns. NEC accounts for 15% ofdeaths in premature babies weighing less than n pr m ur w g ng n

1500 grams. Overall death from those babieswith NEC is 25%.

What causes NEC?

It is now thought that NEC is the result of a combination of several factors. The two consistent findings are prematurity and feedings.

The premature intestine reacts abnormally and develops an acute inflammatory response tofeedings leading to intestinal necrosis (death).

What are the signs and symptoms of NEC?

NEC is difficult to diagnose. The babymay have lethargy, poor feeding, bilious vomiting, distended abdomen and blood i l Ph i l i i h in stools. Physical examination may show the baby to have abdominal tenderness, periumbilical darkening or erythema (redness, or a fixed loop of bowel that can be felt.

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Medical management consists of stopping feeds, nasogastric drainage to suction (tube in baby’sstomach to "suck out" contents), 7-14 days of

antibiotics and IV nutrition. Close monitoring of

How is NEC managed?

fluid status, electrolytes, coagulation and oxygen requirements are also necessary. 60-80% of babies with NEC are managed medically and symptomsresolve without surgery. Feedings postoperatively are started slowly.

What if surgery is needed?

Surgery is necessary if medical management fails or the bowel is perforated (torn). After opening the abdomen, the surgeon may find aswollen, purple bowel with areas of necrosed (dead) bowel.