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  • 8/9/2019 Colon Atresia 2

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    Gh}av}ghie I}|avgi ihm V}ah`vgv

    I

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    9 pi}gah} rg}d `cpdie`faea ihm < pi}gah}v rg}d biv}|`v#fdgvgv dim laah mgibh`vam p|ahi}ieew lw qe}|iv`h`b|ic(M`rh vwhm|`ca $}|gv`cw 2!' $cqf`vie ral [}wpaGS gh 17 [>=!S% ngl|`qv f |m [}wpa GGS gh 9> [92!S% `| f`c#pea}a vapi|i}g`h [}wpa GGGS gh 92 [94!S' ihm v}ah`vgv gh=> $66!' $Ngbq|a '

    Gcpa|n`|i}a ihqv 2 $1'

    Vkaea}ie 4 $>'

    Fah}|ie ha|~`qv vwv}ac = $6'

    @}da|* 99 $4'

    *@}da| ghmgfi}av immg}g`hie ih`ciegav(

    ]ilea '

    Vaf`hm mgv}ie ral < $9(1'

    F`e`hgf i}|avgi < $9(1'

    Af}`pgf pihf|ai}gf |av}v < $9(1'

    Cafkae mg~a|}gfqeqc < $9(1'

    Jajqhie mqpegfi}g`h fwv}v 9 $9'

    Ngbq|a 9( Ilm`cghie |img`b|ipd mac`hv}|i}ghb }da fdi|if}a|gv}gf

    m`qlea#lqllea vgbh ivv`fgi}am rg}d mq`mahie i}|avgi(

    V}ah`vgv

    $66!'

    ]wpa GG I}|avgi

    $9

    ]wpa GGG I}|avgi

    $9

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    ]da`pa|i}g~a c |}ieg}w |i}a riv =! $1/964' n | }davapi}gah}v( Iee 1 mai}dv `ffq||am rg}dgh 6? miwv `n vq|#ba|w ihm ra|a i}}|glq}am }` f`cpeat f`hbahg}ie dai|}ih`ciegav( Immg}g`hie ei}a mai}dv }di} `ffq||am gh 9=$9?!' `n }da fdgem|ah ra|a |aei}am }` vapvgv ihm cqe}g#vwv}ac `|bih nigeq|a $ghfeqmghb fi|mgif nigeq|a' gh > $=!'%cahghbg}gv gh 9 $?(2!'% dapi}gf nigeq|a n`ee`rghb `|}d`#}`pgf eg~a| }|ihvpeih}i}g`h n`| lgegi|w i}|avgi gh 9 $?(2!'%ihmf`cpeat f`hbahg}ie dai|} mgvaiva gh = $6!'( ]r` fdge#

    m|ah $9!' mgam i} d`ca `n qhkh`rh fiqvav( ]da `~a|ieee`hb#}a|c vq|~g~ie |i}a gh qp }` 91 wai|v n`ee`r#qp riv4>! $997/964'(

    JAJQH@GEAIE I]\AVGI

    Jajqh`geaie `lv}|qf}g`h riv n`qhm gh 9!' `n }da9 nacieav $=4!' ihm >2 cieav$1!' ihm `cpdie`faea gh < $9(1!'( _|ahi}ieqe}|iv`h`b|ipdw riv vqbbav}g~a `n gh}av}ghie `lv}|qf#}g`h gh 62 na}qvav $

    b|ipdv qvqieew vd`ram ih qhqvam cgf|`f e`h% i nghmghb}di} |a~aiev }da `lv}|qf}g`h gv egcg}am }` }da vciee gh}av#}gha( ]da li|gqc ahaci iev` m`fqcah}am }da e`fi}g`h`n }da fafqc% iea|}ghb qv }` ghv}ihfav `n ivv`fgi}am mgv#`|ma|v `n gh}av}ghie |`}i}g h ihm ngti}g h( N|aa ig| riv `l#va|~am `h peigh ilm`cghie |img`b|ipdv gh < ha`hi}av$9(>!'( Ivv`fgi}am f`hbahg}ie ih`ciegav ghfeqmam `c#pdie`faea gh < ha`hi}av $9(>!'% fi|mgif ih`ciegav gh 9?$4!'% vkaea}ie ih`ciegav gh 6 $

    I} }da }gca `n vq|ba|w% l`rae `lv}|qf}g`h $ai|ew ihm ei}a' gh 69 pi}gah}v $

    ]da `pa|i}g~a c`|}ieg}w |i}a riv 9 $?(4!' gh 9

  • 8/9/2019 Colon Atresia 2

    4/8

    m|`ca ihm ]_H mapahmahfa ra|a }|ai}am rg}d b|`r}dd`|c`ha% beq}icgha% ihm c`mgngam mga}v% rg}d i vgbhgng#fih} |amqf}g`h gh }dag| ]_H |ayqg|acah}v% ghf|aivam ah#}a|ie gh}ika% ihm baha|ie v`ci}gfb|`r}d( ]da `~a|iee e`hb#}a|c vq|~g~ie |i}a riv 4=!(

    F@E@HGF I]\AVGI

    ]rah}w#`ha $4!' `n }da ha`hi}av $!' `n }da pi#}gah}v vd`ram i mgei}am gh}av}gha rg}d ig|#neqgm ea~aev( \i#mg b|ipdv `l}igham rg}d f`h}|iv} li|gqc ahacivvd`rami mgv}ie cgf|`f`e`h gh 9= ha`hi}av $>2!'( ]r` ha`hi}av$9?!' vd`ram i ei|ba e``p `n gh}av}gha rg}d i v`ip#lqllea ippai|ihfa gh }da |gbd} e`ra| yqim|ih} `n }da il#m`cah( ]da = ha`hi}av rg}d biv}| vfdgvgv dim dim }da il#m`cghie riee manaf} ma}af}am `h p|ahi}ie qe}|iv`h`b|icv(

    I} }da }gca `n vq|ba|w% 97 pi}gah}v $7?!' dim f e`hi}|avgiv% 6 $9>!' rg}d }wpa G $cqf`vie ral'% 9 $1!' rg}d}wpa GG $ngl|`qv f`|m'% ihm 91 $27!' rg}d }wpa GGGi $cav#ah}a|gf bip manaf}'( ]r` pi}gah}v $7(1!' dim f e`hgf v}a#h`vgv( ]da f`e`hgf i}|avgi riv e`fi}am gh }da |gbd} f`e`hgh 4 pi}gah}v $64!'% }|ihv~a|va f`e`h gh 9? $=4!'% ihmean} f`e`h gh 6 $9=!'( Agbd}aah $71!' `n }dava pi}gah}vra|a }|ai}am rg}d }dan`|ci}g h `n i }acp |i|w v}`ci$ahmgea v} cw gh 6 [92!S% |gbd} f`e v} cw gh 6 [92!S% }|ihv#~a|va f e v} cw gh 7 [1?!S% ihmean}f e v}`cw gh 6 [92!S'n`ee`ram lw maeiwam l`rae ihiv}`c`vgv i} iba 6 }` =c`h}dv( ]d|aa pi}gah}v $92!' ra|a }|ai}am rg}d |avaf#}g`h ihm p|gci|w l`rae ihiv}`c`vgv( ]da p`v}`pa|i}g~aihm e`hb#}a|c vq|~g~ie |i}a riv 9??!( F`cpegfi}g hv gh#

    feqmam r`qhm ghnaf}g`h gh 9 ghnih} $1!'% f e`v}`cw p| #eipva gh 9 $1!'% p|`e hbam geaqv gh < $7(1!'% ihm ei}a im#davg~a l`rae `lv}|qf}g`h gh 4 $=?!'(

    F@CCAH]

    Gh}av}ghie i}|avgi gv i f`cc`h fiqva `n ha`hi}ie gh}av}g#hie `lv}|qf}g`h( ]da fiqvav% feghgfie p|avah}i}g`h% mgib#h`vgv% `pa|i}g~a cihibacah}% p`v}`pa|i}g~a fi|a% ihm `q}#f`ca ciw ~i|w f`hvgma|ilew iff`|mghb }` }da e`fi}g`h`n }da `lv}|qf}g`h(

    ]da < cij`| }da`|gav |abi|mghb }da a}g`e`bw `n gh#}av}ghie i}|avgi i|a ]ihmea|v < f`hfap} `n i eifk `n |a#~ifq`egzi}g`h `n }da v`egm f`|m v}iba `n gh}av}ghie ma~ae#

    `pcah} ihm }da feivvgf v}qmw lw E`qr ihm Li|hi|m6vqbbav}ghb }di} i ei}agh}|iq}a|ghacavah}a|gf ~ivfqei| if#fgmah} gv }da fiqva `n c`v} jajqh`geaie ihm f`e`hgf i}|a#vgiv( Rdgea eifk `n |a~ifq`egzi}g`h gv }da p|`lilea fiqvan`| c`v} fivav `n mq`mahie i}|avgi% f`cpaeeghb `lva|~i#}g`hv n|`c `}da| v}qmgav=#9? mac`hv}|i}a }di} jajqh`geaiei}|avgiv `ffq| iv i |avqe} `n gh}av}ghie ~`e~qeqv% gh}qvvqv#fap}g`h% gh}a|hie da|hgi% `| v}|ihbqei}g`h gh i }gbd} biv#}|`vfdgvgv `| `cpdie faea manaf}( Nicgegie ghv}ihfav `n ja#jqh`geaie ihm f`e`hgf i}|avgiv di~a iev` laah `lva|~am%vqbbav}ghb }di} baha}gfv ciw peiw i pi|} gh }dava fivav(99#96

    ]da feivvgngfi}g h `n gh}av}ghie i}|avgiv ~i|gav v`ca#rdi} livam `h }da e`fi}g`h `n }da `lv}|qf}g`h( Mq`ma#hie eavg`hv dgv}`|gfieew di~a laah feivvgngam lw }da ca}d`mmavf|glam lw B|iw ihm Vkihmieikgv% 9= rg}d gmah}gngfi#}g h `n 6 }wpav `n eavg hv( I }wpa G manaf} |ap|avah}v i cq#f`vie ral rg}d h`|cie cqvfqei| riee $c`v} f`cc`h';}wpa GG% i vd |} ngl|`qv f`|m f`hhaf}ghb }da < i}|a}gf ahmv`n }da mq`mahqc; ihm }wpa GGG $eaiv} f`cc`h'% `ha ghrdgfd }da|a gv f`cpea}a vapi|i}g`h `n }da i}|a}gf ahmv(

    ]da feivvgngfi}g`h `n jajqh`geaie i}|avgiv ghg}gieew p|`#p`vam lw E`qr91 iev` |af`bhgzam 6 }wpav `n eavg`hv( ]dafeivvgngfi}g h rivei}a| |angham lw Ci|}ghihm Za|aeei9> ihmlw B|`vnaem a} ie92 }` ghfeqma }da ippea paae man`|cg}wihm cqe}gpea i}|avgiv( Iff`|mghb }` }dgv ca}d`m `n feiv#vgngfi}g`h% }wpa G manaf} |ap|avah}v i cqf`vie manaf} rg}dih gh}if} cavah}a|w( ]wpa GG manaf}v f`hvgv} `n i ngl|`qvf`|m f`hhaf}ghb }da i}|a}gf l`rae ahmv( I }wpa GGGi ea#vg`h mah`}av ih i}|a}gf vabcah} rg}d i ^#vdipam cavah#}a|gf bip manaf}% rdgea }wpa GGGl manghav }da ippea paae ma#n`|cg}w% gh rdgfd }da|a gv i p|`tgcie jajqhie i}|avgi ihm}da mgv}ie l`rae gv vqppegam lw i vghbea |a}|`b|ima le``m~avvae( ]wpa G^ mavf|glav ghv}ihfav `n cqe}gpea i}|avgiv$v}|ghb `n viqviba annaf}'( ]dgvfeivvgngfi}g`h vwv}ac div

    iev` laah ippegam }` f`e`hgf i}|avgi% rg}d c`v} `n }d`vafivav mac`hv}|i}ghb i }wpa GGGi manaf}(]da p|avah}ghb vwcp}`cv n`| pi}gah}v rg}d ihw n`|c

    `n gh}av}ghie i}|avgi `| v}ah`vgv i|a f`hvgv}ah} rg}d l`rae`lv}|qf}g`h ihm ghfeqma lgeg`qv ~`cg}ghb% ilm`cghie mgv#}ahvg`h% ihmnigeq|a}` pivv caf hgqc gh ghv}ihfav `n e`ra|`lv}|qf}g`h( C`v} ghnih}v rg}d mq`mahie `lv}|qf}g`h m`h`} di~a vgbhgngfih} ilm`cghie mgv}ahvg`h( ]da hqcla|`n fivav `n gh}av}ghie i}|avgi }di} i|a gmah}gngam p|ahi#}ieew div ghf|aivam iv i |avqe} `n }da |`q}gha qva `n qe}|i#v`h`b|ipdgf c`hg}`|ghb `n na}ie ma~ae`pcah}( ^i|g`qvv}qmgav94%97 di~a a~ieqi}am }da haam }` pa|n`|c p|ahi}ieaticghi}g h ai|ew $94 raakv bav}i}g h'ihm di~avd`rh}da lahang} `n p|ahi}ie mgibh`vgv rg}d ai|ega| |af`bhg#

    }g`h% p|`cp} vq|bgfie gh}a|~ah}g`h% ihm nara| ca}il`egff`cpegfi}g`hv( _|ahi}ie qe}|iv`h b|ipdw ciw gmah}gnw }dap|avahfa `n ci}a|hie p`ewdwm|ichg`v ihm mgv}ahvg`h `n}da v}`cifd ihm mq`mahqc rg}d vriee`ram ichg`}gfneqgm( ]dava `lva|~i}g`hv i|a `n}ah ivv fgi}am rg}d i dgbd|gvk `n mq`mahie i}|avgi( Ie}d`qbd biv}|`vfdgvgv fih n|a#yqah}ew la `lva|~am `h i p|ahi}ie qe}|iv`h`b|ic% i h`#}ilea hqcla| `n jajqh`geaie ihm f`e`hgf i}|avgiv |acighqhma}af}am lw }dgv ca}d m( Lafiqva qe}|iv`h b|ipdw bah#a|ieew div h } laah ih iffq|i}a ma}a|cghih} n`| e`ra| gh#}av}ghie `lv}|qf}g`h% g}v ilgeg}w }` atfeqma i cien`|ci#}g`h gv egcg}am(

    _`v}hi}ieew% |img`b|ipdgf v}qmgav i|a qvanqe gh }damgibh`vgv `n gh}av}ghie i}|avgi( _eigh ilm`cghie |img`#

    b|ipdv fih gmah}gnw }da feivvgf m`qlea#lqllea vgbh $ig|#ngeeam v}`cifd ihm p|`tgcie mq`mahqc' `n mq`mahie i}|a#vgi `| v}ah`vgv( Eifk `n l`rae biv law`hm }da vaf`hmlqllea gv qvqieew mgibh`v}gf `n ih i}|avgi( Jajqh`geaie `|f`e hgf i}|avgiv i|a fdi|if}a|gzam |img b|ipdgfieew lw }dap|avahfa n p|`tgcie mgei}am gh}av}ghie e``pv n}ah ivv`#fgi}am rg}d ig|#neqgm ea~aev( ]da p|avahfa `n gh}|ipa|g}`#haie fiefgngfi}g`hv i|a ghmgfi}g~a `n caf`hgqc pa|g}`hg#}gvihmvqbbav} ih gh}|iq}a|gha l`rae pa|n |i}g`h( Ih qppa|biv}|`gh}av}ghie f`h}|iv}#ahdihfam |img`b|ipd vd`qem la`l}igham gh fivav `n pi|}gie `lv}|qf}g`h ihm ciw mac#

    I\FD VQ\B/^@E 966% CIW 9774=76

    9774 Ica|gfih Camgfie Ivv`fgi}g`h( Iee |gbd}v |ava|~am(`h Mafacla| 92%

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    `hv}|i}a }da p|avahfa `n i v}ah`vgv `| i cqf vie ral rg}di vciee `pahghb( Iv }da f e`hgf diqv}|ie ci|kghbv i|a h }p|`cghah} gh }da ha`hi}a% g} ciw la mgnngfqe} }` mgvfa|hvciee l`rae n|`c ei|ba l`rae `h peigh ilm`cghie |img`#b|ipdv( I li|gqc ahaci rgee mangha }da e`fi}g`h `n i f`#e`hgf i}|avgi; g} gv iev` |af ccahmam n`| ghv}ihfav `n p|a#vqcam jajqh`geaie i}|avgi }` gmah}gnw rda}da| }da f`e`hdiv laah qhqvam $cgf|`f`e`h' mq|ghb gh}|iq}a|gha egna%mangha }da ea~ae `n `lv}|qf}g`h gh }da vciee gh}av}gha% `f#

    fivg`hieew gmah}gnw }da p|avahfa `n `lv}|qf}ghb gh}|ieq#cghie caf`hgqc paeea}v gh ghv}ihfav `n caf`hgqc ge#aqv% ihm gmah}gnw }da e`fi}g`h `n }da fafqc }` |qea `q}ih`ciegav `n |`}i}g`h ihm ngti}g`h(

    _\A@_A\I]G^A ]\AI]CAH] gh~`e~av ghva|#}g`h `n ih `|`biv}|gf vqcp }qla }` ma#f`cp|avv }da v}`cifd% ihm imayqi}a gh#}|i~ah`qv neqgm |avqvfg}i}g`h }` f`||af}dwp`~`eacgi ihm aeaf}|`ew}a ilh |cieg}gav

    ihm }` ifdga~a dac`mwhicgf v}ilgegzi}g`h( Gh ha`hi}avrg}d mq`mahie i}|avgi% i fi|anqe cgmegha a~ieqi}g`h n`|ivv`fgi}am ih`ciegav gv pa|n`|cam% iv }dgv manaf} p|`l#

    ilew `ffq|v ai|ega| gh bav}i}g`h ihm gv ivv`fgi}am rg}d ihghf|aivam |gvk `n cien`|ci}g`hv gh `}da| `|bih vwv}acv(Fi|mgif ihm |ahie qe}|iv`h`b|ipdgf aticghi}g`h i|a gh#mgfi}am `rghb }` }da dgbd ghfgmahfa `n ivv`fgi}am ma#naf}v(2%

  • 8/9/2019 Colon Atresia 2

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    }ipa|ghb ah}a|`peiv}w gv hafavvi|w }` maie rg}d }da vgb#hgngfih}ew mgei}aml`rae `n }da ghg}gie i}|avgi% gh fivav rg}dcqe}gpea i}|avgiv }da mgv}ie `hav i|a h`} mgv}ahmam( Mg#|af} ahm#}`#ahm ihiv}`c`vgv rg}d`q} |avaf}g`h n`| }wpaGG `| }wpa GGGi mgv}ie i}|avgiv }di} i|a vapi|i}am lw i f`|m`| bip% `| ih ah}a|`}`cw ihm ral atfgvg`h rg}d }|ihv#~a|va fe vq|a `n }da ah}a| }`cw n`| mgv}ie }wpa G cqf`vieral% i|a iffap}ilea(

    @pa|i}g~a f`||af}g`h `n f`e`hgf i}|avgi div laahc`mgngam `~a| }da wai|v( Ai|ega| v}qmgav92%67#=9 |af`c#cahmam |avaf}g`h rg}d ihiv}`c`vgv n`| f`e`h i}|avgip|`tgcie }` }da vpeahgf neatq|a% ihm f`e`v}`cw rg}dmaeiwam ihiv}`c`vgv n`| i}|avgi mgv}ie }` }dgv p`gh}( Ghg#}gie f`e`v}`cw rg}d maeiwam ihiv}`c`vgv riv }da |`q#

    }gha p|if}gfa n`| c`v} ghnih}v gh `q| v}qmw( Gh |afah}wai|v% d`ra~a|% va~a|ie iq}d`|v=

  • 8/9/2019 Colon Atresia 2

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    =( Vih}qeeg ]^%Leihf RI(F`hbahg}iei}|avgi`n }da gh}av}gha: pi}d bahavgvihm }|ai}#

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  • 8/9/2019 Colon Atresia 2

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    fi}g`hgh }dacij |g}w `n pi}gah}v(I|aw`qqvghb p| pdweitgv% vqfdiv p``|ew ilv`|lam l|`im vpaf}|qc ih}glg`}gfv% }` i}}acp} p|a#~ah}g`h `n |afq||ah} vapvgv gh }dava dgbd#|gvk ghnih}v0

    Vaf`hm% w`q |ap |}am }|ai}ghb va~a|ie ghnih}v rg}d b|`r}dd`|c`ha ihm dgbd#beq}icgha mga}v iv M`qbeiv Rgec`|a div |a#p`|}am gh imqe} pi}gah}v( Gv g} w`q| gcp|avvg`h }di} }dgv div gc#p| ~am bq} nqhf}g h% `| m`av g} iffaea|i}a }da imip}i}g h gh }davaghnih}v% `| l`}d0 Vd`qem ra v}i|} qvghb b|`r}d d`|c`ha gc#camgi}aew in}a| |avaf}g h gh iee ghnih}v rg}d vd`|} l`rae eahb}d0I|a }da|a ihw r`||gv`ca vgma annaf}v n|`c }dgv camgfi}g`h0

    N|ama|gfkC( Ki||a|% CM%Mah~a|% F`e : ]dgv vacghie pi#pa| gv b`ghb }` la i lahfdci|k n`| `q| vpafgie}w% iv cihw `n}da iq}d`|v f`h}|glq}g`hv di~a laah( ]da iq}d |v di~a e``kami} i ~a|w ei|ba b|`qp `n fdgem|ah ihm fi|anqeew v}qmgam }dac `~a|i e`hb pa|g`m( Cw yqav}g`h |aei}av }` `ha pi|}gfqei| vabcah}`n }da p`pqei}g`h% hicaew% }d`va rg}d jajqh`geaie i}|avgi( D`rriv}da vaeaf}g h `n |avaf}g`h ihmp|gci|wihiv} c`vgv ~v }ac#p`|i|w `v}`cw ihm ei}a| ihiv}`c`vgv cima0 Ra|a ihw `n }dapi}gah}v gh }da b|`qp rd` dim }acp`|i|w `v}`cgav qhf`c#pegfi}am0 Gn v`% d`r mgm }daw ni|a f`cpi|am }` }da `hav rd`dim p|gci|w ihiv}`c`vgv0 @ha p|ana|ahfa gv n`| |avaf}g`h ihmp|gci|w ihiv}`c`vgv rdaha~a| p`vvglea(

    Di|eih M( \``}% CM% Vih Ih}`hg`% ]at: G di~a i yqav#}g`h livam c`|a `h fq|g`vg}w }dih `h im~`fifw( Gv }da|a ihw|`ea n`| p|ahi}ie p|amaeg~a|w gh}|iq}a|gha p|`famq|av0 G h`#}gfam gh }da mq`mahie i}|avgi b|`qp }da|a riv i