1. Pediatric Surgery Care Bby By Susheewa Wichaikull

2. Lower Gastrational Tract

3. 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.

4. 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

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

6. 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.

8. 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.

9. อาการ ไม่ถ่ายขี้เทา ท้องอืด ขาดน้ำ การรักษา High Type และ Intermediate ทำผ่าตัด Colostomy เมื่อเด็กอายุ ประมาณ 1 ปี หรือน้ำหนัก 10 kg ทำ Abdominperineal pull-Through Low Type ทำ Anoplasty การพยาบาล ก่อนผ่าป้องกันท้องอืด หลังผ่าตัดป้องกันการติดเชื้อที่แผล แช่ก้น บางที่ใช้ Nss Providine เช็ด

10. 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

11. 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.

12. 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.

13. 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.

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

15. 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.

16. 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 1500 grams. Overall death from those babies with NEC is 25%.

17. 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).

18. 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.

19. Medical management consists of stopping feeds, nasogastric drainage to suction (tube in baby’s stomach to "suck out" contents), 7-14 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 NEC managed?

20. 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.