lower gi
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Pediatric Surgery Care
Bby By Susheewa Wichaikull
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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.
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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
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Surgical repair involves creating an opening for
passage of stool. Complete absence of an anal opening
requires emergency surgery for a newborn.
Treatment
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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.
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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 and
continue for some months. Stool softeners and a
- high residue diet will need to continue throughout
childhood.
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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
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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
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- 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.
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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.
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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.
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Treament of diverticulitis and diverticular bleeding
involves surgical removal of the segment of colon
containing the diverticula.
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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.
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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%.
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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).
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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.
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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?
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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.
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