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 portion

of bowel (rectum). Through complex nerve and

muscle structures, the rectum releases stool through

the anus out of the body.

An imperforate anus is a malformation of the

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.

Imperforate anus

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 intermediat

imperforate anus defect usually involves creation

of a temporary opening of the large intestine (colon)

onto the abdomen to allow passage of stool (this is

called a colostomy). The baby is allowed to grow

for several months before attempting a more

complex anal repair.

Through an anal incision, the rectal pouch is pulled

down into place, and the anal opening is completed.

The colostomy may be closed during this stage or

may be left in place for a few more months and

closed at a later stage.

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 and

continue for some months. Stool softeners and a

- high residue diet will need to continue throughout

childhood.

อาการ ไม่ถ่ายขี้ �เทา ท�องอ�ด ขี้าดน้ำ��า

การร�กษา High Type และ Intermediate ท�า

ผ่าตั�ด Colostomy เม่��อเด�กอาย ประม่าณ 1 ป# หร�อน้ำ��าหน้ำ�ก 10 kg ท�า

Abdominperineal pull-Through

Low Type ท�า Anoplasty การพยาบาล กอน้ำผ่าป'องก�น้ำท�องอ�ด

หล�งผ่าตั�ดป'องก�น้ำการตั(ดเชื้��อท �แผ่ล แชื้ก�น้ำ บางท �ใชื้�Nss Providine เชื้�ด

The colon, or large intestine, is a muscular tube

that begins at the end of the small intestine and

runs 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 in

fiber. By the age of 60, over half of all Americans

have colonic diverticula.

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 segment

of colon containing the diverticula.

Diverticula can also bleed and cause significant blood

loss 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 healthy

ends of the colon are sewn back together.

Occasionally, especially in cases of diverticulitis,

where there is significant inflammation, a colostomy

is performed.

Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) affects mainly

premature babies . It is the most common surgical

emergency in newborns. NEC accounts for 15% of

deaths in premature babies weighing less than

1 5 0 0 grams. Overall death from those babies

with 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 to

feedings leading to intestinal necrosis (death).

What are the signs and symptoms of NEC?

NEC is difficult to diagnose. The baby

may have lethargy, poor feeding, bilious

vomiting, distended abdomen and blood

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.

Medical management consists of stopping feeds,

nasogastric drainage to suction (tube in baby’s

stomach to "suck out" contents), - 7 1 4 days of

antibiotics and IV nutrition. Close monitoring of

fluid status, electrolytes, coagulation and oxygen

requirements are also necessary . - 60 80% of babies

with NEC are managed medically and symptoms

resolve without surgery. Feedings postoperatively

are started slowly.

How is NECmanaged?

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 a

swollen, purple bowel with areas of necrosed

(dead) bowel.