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Published by: susheewa on Jan 23, 2009
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Pediatric Surgery Care
By Susheewa Wichaikull
Imperforate Anus( Anorectal)
In individuals with a normal anatomy, the largeintestine (colon) empties into a pouch-like portionof bowel (rectum). Through complex nerve andmuscle structures, the rectum releases stool through e anus ou o e oy.An imerforate anus is a malformation of the
Imperforate anus 
anorectal region that may occur in several forms.The rectum may end in a "blind pouch"--one thatdoes not connect with the colon--or it may haveopenings to the urethra, bladder, or vagina. Acondition of stenosis, or narrowing of the anus,or an absence of the anus may also be present.Surgical repair involves creating an opening forpassage of stool.Complete absence of an anal openingrequires emergency surgery for a newborn.
Surgery for ahigh-type and intermediatimperforateanus defect usually involves creationof 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 growfor several months before attempting a more.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 andclosed at a later stage.
The child may require several days in the hospital.Dilatation of the new anus (to improve muscle toneand prevent narrowing) will begin in the hospital andcontinue for some months. Stool softeners and ahigh-residue diet will need to continue throughoutchildhood.
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ขาดนํ  ้
High Type
เมื อเด็กอายุ
หรือนํ าหนั
10 kg
Abdominperineal pull-Throuh
Low Type
หลังผ ่าตัดป  ้องกันการติดเชื้อที ่แผล
แช ่  ้
Nss Providine
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 fromliquid stool that is delivered to it fromthe 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
, over half of all Americanshave colonic diverticula.In most cases diverticula o unnoticed However
, . ,in a small percentage of patients, diverticula cancause problems. The most common problem isdiverticulitis, which occurs when a small, hard pieceof stool is trapped in the opening of the diverticula.This leads to inflammation and death of the segmentof colon containing the diverticula.
Diverticula can also bleed and cause significant bloodloss from the gastrointestinal tract. Vesselsoverlying a diverticula are stretched until they break,causing bleeding into the colon. Blood isusually passed in the stool.Treament of diverticulitis and diverticular bleedinginvolves surgicalremoval of the segmentof coloncontaining the diverticula.After thediseased 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 surgicalemergency in newborns.NEC accounts for
% ofdeaths in remature babies weihin less than
grams.Overall death from those babieswith NEC is
What causes NEC?
It is now thought that NEC is the result of acombination of several factors. The two consistentfindings areprematurity and feedings
Theprematureintestine reactsabnormally and developsan acute inflammatory response tofeedings leading to intestinal necrosis (death).
What are the signs and symptoms of NEC?
NEC is difficult to diagnose. The babymay havelethargy, poor feeding, biliousvomiting, distended abdomen and bloodin stoos. Pysica examination may sowthe baby to haveabdominal tenderness
periumbilical darkening or erythema(redness, or a fixed loop of bowelthatcan be felt.

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