High atresia of the rectum in newborns. Therapeutic measures taken in children with atresia

ATRESIA OF THE ANUS AND RECTUM honey.
Atresia anus and rectum - the absence of a natural channel of the rectum and / or anus; developmental anomaly.

Frequency

1:500-1:5000 live births. The predominant gender is male (2:1).
Genetic aspects. Exist hereditary forms atrezium
Syndromes VATER and VACTERL. (192350). Clinical picture: atresia of the anus, esophagus, duodenum and rectum, esophageal-tracheal fistula, pulmonary hypoplasia, dysplasia radius, six-fingered, hypoplasia femur, abnormal position of the thumb, ventricular septal defect, renal agenesis, atresia urethra and , vertebral defects (hemivertebrae)
VACTERL syndrome and hydrocephalus (314390, 8 or p). Clinical picture: combination of VACTERL syndrome and hydrocephalus
Vertebral-costal dysostosis with atresia of the anus and urogenital anomalies (271520, p): atresia of the anus, genitourinary anomalies, the only umbilical artery, severe dysplasia of the ribs and vertebrae, an unusual shape of the chest.

Classification

Atresia
Cloacal form*
cystic
vaginal
with fistulas
in urinary system in boys (into the bladder and urethra)*
in reproductive system in girls (uterus*, vagina*, vaginal vestibule)
on the perineum in boys and girls (in boys also on the scrotum and penis)
No fistula
atresia of the anus and rectum*
anal atresia
covered anal opening
rectal atresia with a normally developed anus
Note. An asterisk (*) marks high forms of atresia (supra-levator, the blind sac of the rectum is located above 2-"-2.5 cm from the skin). All the rest are classified as low (sublevator).

Clinical picture

Usually detected during the initial examination of the newborn in the maternity hospital.
If for some reason the child was not examined after birth, then by the end of the day the newborn begins to worry, profuse regurgitation appears, vomiting of the contents of the stomach, then bile, and in late dates- mekonyom. The abdomen gradually becomes swollen. Meconium and gases do not depart. Developing a pattern of low intestinal obstruction.
Physical examination in the first hours after birth: establish the type of atresia and its height.
Covered anus is the mildest form of low atresia. At the site of the anus, a translucent membrane is revealed.
Anal atresia: also classified as low. At the site of the anus, a slight depression of the pigmented area of ​​the skin is found. When pressing on it, balloting is felt due to the low location of the rectum.
Atresia of the anal canal and rectum: referred to as high forms of atresia. The perineum is usually reduced in size, underdeveloped. Often the coccyx is underdeveloped or absent, sometimes the sacrum. At the site of the anus, the skin is most often smooth.
Rectal atresia (isolated) can be high or low. The anal opening with a well-formed external sphincter is located on usual place. To establish the diagnosis, it is enough to insert a catheter through the anus or conduct a digital examination.
A fistula in the reproductive system occurs exclusively in girls. The main symptom is the release of meconium, and then feces and gases through the genital slit.
A fistula into the urinary system (bladder, urethra) occurs almost exclusively in boys. The main symptom is the passage of meconium and gases through the external opening of the urethra.
The cloacal form of atresia is the most complex of all anorectal malformations. During the examination, the absence of the anus is found. In the place where the external openings of the urethra or vagina should be, there is one - the exit of the cloaca, into which the urethra, vagina and rectum open. Anatomical forms cloacae are diverse, so a detailed examination is necessary.
Fistula on the perineum occurs in boys and girls. Diagnosis is based on external examination.
Combined malformations in various combinations often occur with atresia of the anus and rectum (renal aplasia, hypospadias, megaureter, hypospadias, doubling of the kidney and ureter, etc.).

Research methods

X-ray according to Wangestyn. The place of the natural location of the anus is marked with a radiopaque object (coin, pellet, etc.). The child is wrapped in diapers, leaving the legs open, placed under the X-ray screen and lowered upside down. The height of atresia is judged by the distance between the blind end of the intestine (gas bubble) and the label
Lunction method according to Sitkoesky. A thin needle with a syringe is used to pierce the skin of the perineum at the natural location of the anus and, pulling the piston, insert the needle towards the intestine until a drop of meconium appears in the syringe. The height of atresia is judged by distance
ultrasound
Catheterization of the urethra - diagnosis of a fistula in its membranous part
Urethrocystography facilitates the diagnosis of a fistula in the urinary system
Laparoscopy is indicated to clarify the condition of the internal genital organs.

Treatment:

Methods

surgical interventions
One-stage radical operations - perineal and abdominoperineal proctoplasty
An unnatural anus is imposed only with contraindications to simultaneous radical operation.
Contraindications for immediate radical surgery
Severe combined malformations
Accompanying illnesses
High rectal atresia in a child with prematurity II-IV degree
The presence of fistulas in the urinary system
The surgeon's lack of experience in abdominoperineal proctoplasty in a newborn. Postoperative management
The child is placed in a heated incubator in the supine position. Legs are spread, bent in knee joints and pulled to the stomach, fixing with a bandage in the dilution position. This position is maintained for 5-10 days.
The toilet of the perineum is carried out several times a day, after each physiological departure
catheter from Bladder removed on day 2, and if the child had a urethral fistula, the catheter is left for 3-5 days
The sutures in the area of ​​the created anus are removed for 10-12 days
Feeding the child after the operation of perineal proctoplasty is prescribed from the first day according to the usual age scheme, after abdominoperineal proctoplasty, it is first prescribed parenteral nutrition, and by the 8th day the patient begins to receive the usual nutrition for his age
Prescribing antibiotics, physiotherapy
For the prevention of narrowing of the anus or its elimination, bougienage is carried out (start from 15-20 days, continue for
3-4 months, and if necessary, longer).

Forecast

Without surgical intervention the patient dies later
4-6 days after birth. Mortality in surgical treatment
- 11-60%. Good results of treatment are achieved in no more than 30-40% of patients.
see also

ICD

Q42 Congenital absence, atresia and stenosis of the large intestine

MSH

192350 VATER and VACTERL syndromes
271520 Vertebral costal dysostosis with anal atresia and urogenital anomalies
314390 VACTERL syndrome and hydrocephalus Notes: VATER - Vertebral defects, Anal atresia, Iracheoesophageal fistula, Јsophageal atresia, Radial dysplasy; VACTERL
- Y_ertebral anomalies, Dpal atresia, Cardiac malformations,
Iracheoesophageal fistula, Esophageal atresia, Renal anomalies, Limb
anomalies

Literature

Jarcho S, Levin PM: Hereditary malformation of the
vertebral bodies. Bull. Johns Hopkins Hasp. 62:216-226, 1938

Disease Handbook. 2012 .

See what "ATRESIA OF THE ANUS AND RECTAL" is in other dictionaries:

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anus

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Rectal atresia is a congenital defect associated with the absence of a person's natural canal of the rectum, as well as the anus. It should be noted that the presented pathology is formed in boys twice as often as in girls. About what are the causes, symptoms and other features of the presented condition, further.

Causes and symptoms of atresia

The formation of rectal atresia is associated with a violation of embryonic formation, in particular, we are talking about non-separation of the cloaca and the absence of perforation of the proctodeum. Yes, at normal development fetus similar divisions occur in the seventh week from the onset of pregnancy. If any failures occur, then abnormal processes are formed in the development of the anus and rectum.

Rectal atresia may be included in the structure of some hereditary syndromes, which, in turn, may be associated with abnormalities in the development of the spinal column, heart, and gastrointestinal tract. In addition, such changes may affect pulmonary system, kidneys, limbs and be associated with the formation of hydrocephalus. Thus, the reasons for the development of this condition, as experts note, may well be controlled even before the birth of the child. That is why it is strongly recommended to take care of your health and remember that the presented condition provokes numerous negative symptoms The child has.

In particular, rectal atresia is associated with clinical manifestations that develop 10-12 hours after birth - this is relevant for those cases where the condition was not identified before delivery. The newborn is restless, does not sleep, refuses to breastfeeding and is struggling. By the end of the day, symptoms associated with low intestinal obstruction begin to develop. In particular, we are talking about non-discharge or problematic excretion of meconium and gases, swelling of the abdominal region.

Not less than severe symptom are vomiting, which are first associated with gastric contents, and after that - with bile and feces.

At the same time, atresia of the rectum can be expressed by severe toxicosis and exsicosis. In case of untimely assistance or its absence, the death of a child may occur from such conditions as aspiration pneumonia, perforation of the intestinal area, as well as peritonitis.

Clinical manifestations that are associated with rectal atresia along with a fistula in the vaginal area should be considered the excretion of meconium (feces) and gases through the genital slit. Acute degree intestinal obstruction is uncharacteristic, at the same time, the constant excretion of intestinal contents through the vagina allows you to create conditions for the formation of such consequences as urinary tract infections, vulvitis in girls. In addition, experts recommend paying attention to the following symptoms:

1. fistulas related to the region of the rectal perineum can open sufficiently from the anus, at the site of the scrotum or at the root of the penis;
2. the skin around the fistula is traditionally macerated;
3. habitual bowel movement is difficult, which explains the early formation of such a phenomenon as intestinal obstruction.

However, in order to maintain 100% confidence in the presence of rectal atresia, it is strongly recommended to conduct a full diagnostic examination. This will also provide an opportunity to chart a subsequent recovery course.

Diagnosis and treatment

In the vast majority of cases, atresia of the rectum and anus is found within initial examination newborn neonatologist. Less often (with an already formed anus, but an atrezed rectum), the condition can be recognized during the first day of a baby's life by the absence of meconium excretion from the body. In addition, experts note the development of such a clinic, which is associated with acute intestinal obstruction.

In a series of priority examinations in order to identify the level of atresia, the baby should be performed such diagnostic examinations, as Wangensteen invertography, ultrasound of the perineum, fine needle puncture of the previously indicated area. To identify the location and degree of usefulness of the external type sphincter, electromyography is performed.

The location of fistulas that open into the urinary system is specified using urethrocystography.

If we talk about fistulas in the perineum, then this is done with the help of a special fistulography.

For clarifying diagnosis, such diagnostic methods as MRI, specialized laparoscopy can be used. Considering that atresia of the rectum can be combined with other defects, it is highly recommended to conduct an ultrasound scan of the kidneys, the heart of a child, as well as esophagoscopy. All this will enable specialists to begin full-fledged treatment as soon as possible.

The presence of any form of rectal atresia implies the implementation surgical correction. Urgent intervention within the first two days of a baby's life is highly recommended for absolute atresia or rectourethral and rectovesical fistulas. In addition, narrow rectovaginal and recto-perineal fistulas, which provoke significant delays in discharge, can be called indications for such an intervention. stool.

With underestimated forms of rectal atresia, a specific perineal proctoplasty is performed. High varieties of atresia of the rectum need a gradual correction of the defect. During the first day of life to eliminate intestinal obstruction and exclude negative consequences sigmostoma is placed.

For extended fistulas in the perineum and vagina, surgery is traditionally performed between the ages of six months and two years. In the period before the procedure, it is strongly recommended to follow a laxative diet, the use of cleansing enemas, bougienage based on the cleansing of the fistulous opening. With the exception of the development of urethral, ​​vesical, vulvar, vaginal fistulas, it is strongly recommended that specialists such as urological surgeons and gynecologists participate in the operation.

All this will make it possible to normalize the work gastrointestinal tract the child and will allow him to maintain an optimal level of life.

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Atresia (infection, obliteration) of the intestine is a congenital pathology of the development of the gastrointestinal tract of a child, which consists in the absence of a lumen in one of its sections.

Depending on the location of the pathology, several types of atresia are distinguished:

• pyloric - located directly after the stomach;
• duodenal atresia - located at the very beginning of the small intestine;
• jejunal atresia - the site is located between the upper and bottom small intestine;
• atresia ileum;
• colon atresia - diagnosed in the region of the rectum and anus.

duodenal atresia

Atresia of the duodenum is formed in the second - third gestational month. For pathology, the complete closure of the lumen of the intestinal tube is typical. In this case, there is a significant expansion of its proximal end, capable of reaching the size of the stomach in its volumes. In this case, the distally located intestinal loops have a small diameter and are soldered together.

Atresia may indicate the following signs:

• regurgitation amniotic fluid;
• after feeding, the child develops vomiting with bile impurities. This is explained by the fact that the infection of the intestine is located below the papilla of Vater;
• the abdomen is painless and soft on palpation, visually drawn in;
• with obliteration of the duodenum, the original feces are observed, but then the stool stops completely;
• on the first day - two after birth, the baby remains calm - general state child is normal. Later, he develops signs of toxicosis and exhaustion: the fat layer disappears, facial features become sharper, the skin becomes dry;
• aspiration pneumonia develops.

If untreated, the child dies within 1.5 weeks from exhaustion and progressive pneumonia.

Diagnosis and treatment

X-ray technique is used to clarify the preliminary diagnosis. The picture will clearly show gas bubbles located in the stomach and duodenum. In this case, the intestinal loops remain free. To obtain a more accurate image, a contrasting technique is used.

On the x-ray quite clearly traced the absence of the site duodenum

Additionally carried out differential diagnosis with other congenital anomalies, in particular, an annular pancreas. Treatment of pathology involves immediate surgical intervention. Its type depends on the location of the atresia relative to the papilla of Vater.

When the gastrointestinal tract is infected, a duodenojejunoanastomosis is applied, if the obliteration is located higher, then a gastroenteroanastomosis is performed. After the operation, the child may experience signs of duodenal dysfunction for quite a long time - regurgitation and vomiting.

Pathology of the small intestine

Atresia thin department intestines in newborns is diagnosed most often in the lower ileum. Slightly less common in the upper gastrointestinal tract. In some cases, the cause of obstruction of the intestinal tube is the presence of a membranous septum.

With atresia of the small intestine in a newborn, a fairly characteristic clinical picture:

• the child develops indomitable vomiting with admixtures of bile blood, later admixtures of feces appear;
• there is no meconium passage;
• after feeding, intestinal peristalsis is significantly increased, clearly visible through the abdominal wall;
• bloating occurs against the background of a decrease in excreted urine, up to the complete cessation of its discharge;
• vomiting leads to the development of toxicosis and rapid loss weight, despite a good appetite.

Symptoms of atresia of the small intestine appear in the first day of a baby's life

A sharp retraction of the abdominal wall indicates a rupture of the intestine. The condition of the newborn is rapidly deteriorating skin acquire a characteristic grey-green color.

The main method of diagnosing pathology - x-ray examination. If, in addition to the characteristic gas bubble, several more bubbles with a level are distinguished, then the location of the atresia is upper divisions GIT.

Numerous air bubbles with fluid levels become a sign of atresia, localized in the lower ileum or at the very beginning of the large intestine. During radiology, the use of barium porridge by mouth is strictly prohibited.

The drug contributes to a significant stretching of the intestine, increasing the risk of perforation, and also increases the urge to vomit.

The disease has a poor prognosis, but in full-term children with early surgery and a small number of atresias, it improves. Surgery is recommended immediately after the detection of pathology.

Rectal atresia

Rectal atresia is a congenital pathology characterized by underdevelopment of the anus. Most often, the anomaly is diagnosed in boys. The disease needs urgent surgical correction, carried out during the first day after birth.

Pathology is formed in the early antenatal period (from 12 to 29 gestational weeks) and is caused by impaired fetal development. The condition is characterized by the absence of an orifice in the proctodeum (an indentation at the posterior end of the body of the fetus that then becomes the anus) and also by the failure to separate the cloaca.

Classification

Atresia of the rectum is usually divided:

• to high (supralevator);
• average;
• low (sublevator).

The second classification of pathology divides atresia of the rectum into total (there is a complete overgrowth of the lumen of the intestinal tube, without a fistula), which occurs only in 10% of all diagnosed cases, and a fistulous format, to which the remaining 90% come.

The fistulous form of rectal atresia is of the following types:

• the pathological channel is displayed in the organs of the urinary system;
• fistulas enter the reproductive system;
• directly into the perineum.

Symptoms

The first clinical signs of pathology are formed 12 hours after the birth of a child - he becomes restless, sleeps poorly, refuses to breastfeed and almost constantly pushes. By the end of the first day of life, symptoms of intestinal obstruction appear: the absence of meconium; the child begins to swell - there is a strong bloating.

Vomiting opens, which contains bile and feces, signs of intoxication and dehydration appear. If the infant does not receive a qualified medical care, then die from perforation of the intestine and subsequent peritonitis.

With low atresia of the rectum, instead of the anus, the child has a small funnel-shaped depression. Sometimes it is completely absent.

In some cases, the anomaly manifests itself as an overgrowth of the intestine, and then the anus is simply blocked by a film through which the accumulated meconium is clearly visible. A sign of this form of pathology is the bulging of the anus during stress, the so-called "push" syndrome. With high, supralevator atresia, it is absent.

After birth, all children, without exception, are tested for congenital anomalies. The anal area is also subject to mandatory inspection. In case of pathology, instead of the anus, the child will have a small depression.

It is important for physicians to determine the severity of the pathology. If the baby is missing only the anus, and the intestine itself is fully developed, then while crying, the child has a protrusion in the region of the anus.

Fistulas that enter the urinary system are diagnosed in most cases in male infants. Girls this variety atresia is much less common. A sign of pathology is the presence of particles of meconium in the urine, and when straining, gases come out of the urethra.

Entry of intestinal contents into urinary tract causes the development of cystitis, pyelonephritis, urosepsis.

A sign of a fistula of the colon, which has access to the vagina, is the release of original feces through the genital gap. Acute intestinal obstruction does not develop with this format of atresia, but the exit of feces in a similar way leads to the formation of vulvitis and various inflammations of the urinary system.

Another option for opening a fistula is the perineal region. Most often, an abnormal canal is formed near the anus, scrotum, or at the base of the penis. It is also impossible to perform a normal act of defecation, so the baby will develop symptoms of intestinal obstruction in the next few hours.

Diagnosis and treatment

To diagnose atresia, an infant is assigned an X-ray examination. In some cases, palpation of the rectum is quite enough, during which the doctor encounters an obstacle.

Treatment of rectal atresia is possible only surgically. Babies with sublevator (low) atresia of the rectum undergo perineal plasty. With an average and high form pathology during the surgical intervention, an end colostomy is formed (the withdrawal of a part of the colon or sigmoid colon to left side abdomen) with subsequent correction.

An infant operated on for intestinal atresia with a colostomy removed

After surgical treatment medium and high atresia children often develop fecal incontinence. Forecast in the absence adequate therapy unfavorable: the death of the child occurs on the fifth - sixth day after birth. But a timely operation is not a guarantee. full recovery. The intestine begins to fully function only in 30% of operated infants.

Colon atresia

Colon atresia is characterized by complete obstruction of this part of the intestine. Pathology is extremely rare and accounts for only 2% of all diagnosed cases of intestinal atresia. The reason for the formation of the anomaly is considered to be intrauterine necrosis of the large intestine as a result of pathological conditions, in particular, inversion.

Signs of colon atresia are formed in an infant on the second or third day. This is indomitable vomiting containing impurities of meconium, bloating. On visual inspection, you can see stretched intestinal loops protruding through the abdominal wall.

Diagnosis includes mandatory x-rays. The image clearly shows numerous gas bubbles with horizontal liquid levels. The intestinal loops are stretched, and the non-functioning segment of the intestine itself looks like a thin cord.

The atrezed area can be diagnosed on any of the sections of the colon

Treatment of the pathology is surgical and consists in the removal of the atrezed section of the intestine, followed by the imposition of a colonic anastomy. In case of rupture of the intestine and the development of peritonitis, a proximal colostomy can be installed.

Intestinal atresia is one of complex anomalies formation of the intestinal tract. After diagnosing the pathology, the infant needs emergency surgical intervention. Otherwise, the disease has an extremely unfavorable prognosis.

Atresia of the anus and rectum are birth defects child development. The word atresia itself means the absence of a hole in the place where it should be. For the presence of this most serious pathology, all newborns are examined immediately after birth. This is due to the fact that children with such defects need urgent surgical treatment, which eliminates intestinal obstruction ( life threatening baby's condition). The examination is carried out by a neonatologist immediately after birth or an obstetrician-gynecologist, if there is the slightest suspicion, a pediatric surgeon is called for a consultation.

Manifestations of atresia of the rectum and anus

The brightness and completeness of the manifestations of this pathology depend on whether the natural opening is completely absent or there are bypass fistulous passages in which the contents of the intestine can exit. The first signs can be seen only after a day, even with complete atresia. Since the rectum is not emptied, and food is constantly supplied, there is a movement of the contents of the intestine in the opposite direction. The baby starts spitting up profusely. First, vomiting occurs with what was eaten the day before, and then the child vomits meconium (this is the name of the first feces of a newborn, it differs in color and consistency from ordinary feces). The baby's tummy increases in volume, inflates. At advanced disease swollen intestinal loops can be seen on the abdominal wall. And the main manifestation of atresia of the rectum and anus is the complete absence of discharge of gases and meconium. Since absorption in the intestine is disturbed, all types of metabolism are disturbed. Due to profuse vomiting, the body becomes dehydrated, the child's condition deteriorates sharply, at first he becomes restless, constantly crying (because his stomach hurts), and then this is replaced by noticeable lethargy.

Diagnosis of atresia of the anus

All newborns in the hospital are examined for the presence of congenital anomalies in the maternity home. Be sure to look for the presence of an anus. With atresia, instead of a hole, there is a small depression, and it also happens that there is not even one.

For the doctor, it is important to establish what character underdevelopment has. So, if only the anus is missing, and the rectum is formed correctly, then when the child cries, a protrusion in the anus is clearly visible. Children with atresia are X-ray pictures according to special methods (the child is turned upside down, and an iron mark is placed on the region of the posterior opening), which makes it possible to determine the severity of the defect and the type of atresia. During examinations, it is determined how high the atresia is located, which in to a large extent distinguishes further medical tactics.

The main difficulty is presented by those cases when there is an anus, and the rectum in any area has atresia. This type of defect cannot be determined during the initial external examination. It is possible to suspect the disease only after the appearance of symptoms such as vomiting and prolonged absence evacuation of stool and gases. But on the basis of only these symptoms it is impossible to make a diagnosis of atresia, it is necessary to conduct a series of examinations that will allow to exclude other pathologies with similar manifestations. It is possible to study the rectum of a newborn with a finger, in which the doctor feels an impassable obstacle.

Sometimes it happens that during prenatal development of the fetus, holes (fistulas) are formed between bladder and rectum, total absence anus openings. This condition is called rectal ectopia. In this case, the child urinates with an admixture of meconium and with gas discharge. Also, fistulas can be external and located in the scrotal region in boys and in the vaginal region in girls.

Therapeutic measures taken in children with atresia

All children who have atresia of the anus and rectum, within the first day after birth, should be transferred from the maternity hospital to the nursery. surgery department hospitals. There they undergo further examination and are operated on urgently. There are exceptions to this rule: those children who have wide fistulous openings that come out on the perineum and allow meconium to pass in full, do not need surgery in the coming months, they can stay in the maternity hospital with their mother until discharge. Surgical treatment for such babies is carried out by the end of the first year of life. By this time, the feces become harder, which can cause intestinal obstruction.

If only the anus is missing, and the rectum is formed correctly, then plastic surgery is performed to create a natural opening. For all other children, the intestine is displayed on the anterior abdominal wall (a colostomy is applied), which allows you to create an outflow for intestinal contents and avoid intestinal obstruction. Then, at the age of about a year, such children undergo a definitive operation, which allows you to get rid of the colostomy. A rectal opening and normal patency of the intestinal tube is created.

The main problem in babies with atresia after surgery is normal adaptation to life in society, the ability to defecate (feces) in such children is different and depends on many circumstances. Each case is individual and has its own approach and its own result.

Under atresia of the anus is meant a disease of newborns, characterized by underdevelopment of the anus or the absence of the anus. Most often, the pathology affects male embryos. Key Factors the occurrence of the disease, scientists consider hereditary anomalies that occur during the development of the fetus.

In order to better understand what an atresia of the anus is, you need to know the structure of the intestines and internal organs.

The structure of the rectum consists of a segment of the large intestine that completes the digestive tract system. This is the distance between sigmoid colon and anus. The rectum is conditionally divided into two parts: pelvic and perineal.

The second division, that is anal canal located in the lower part of the segment, endowed with a narrow section and small dimensions close to 5 cm. It is designed to release intestinal deposits to the outside.

Abnormal formation of the anus or its absence is called "atresia of the anus and rectum."

This defect is detected immediately after the birth of the child when examined by an obstetrician-gynecologist..

If this pathology is not detected for any reason, the newborn develops intestinal obstruction. This can lead to the death of the baby.

In a child with a similar disease meet different anatomical features rectum:

• too narrow anus, located in an atypical place, resulting in painful emptying and deep constipation;
• no exit from the anus on the outside of the body, and the inside of the rectum is connected to internal organs small pelvis. In this case, an infectious fire or obstruction of the rectum is not excluded. The segment between the rectum and organs is commonly called a fistula or fistula;
• the absence of an anus from the outside, and the connection inner region rectum with organs of the genitourinary or reproductive system. This fact causes the unification of the channel for excretion of feces and urine.

Atresia of the anus and rectum is often accompanied by cardiovascular diseases and diseases of the urinary system.

Symptoms of the presence of pathology

If the disease was not recognized at birth, anus atresia in newborns manifests itself in the next 12 hours after the birth of the baby. He refuses to eat, is naughty, does not sleep well.

Since according to physiological characteristics The emptying of the intestines of the infant should occur in the first 24 hours of life, its absence is accompanied by the following manifestations:

• lack of excretion of original feces;
• excretion of vomit containing mother's milk, and subsequently feces and bile;
• intoxication and dehydration of the body.

Diagnosis of the disease

Failure to provide timely qualified assistance leads to lethal outcome . In this regard, if there is a suspicion of rectal atresia in a newborn in as soon as possible necessary comprehensive examination child. To do this, the following activities are carried out:

• visual examination of the child by a surgeon;
• ultrasound examination of the pelvic organs;
• x-ray to determine the height of atresia;
• fine needle puncture of the colon;
• electromyography.

How to help a newborn baby with constipation? Read.

Treatment of the disease

If a child was born without an anus, it is possible preventive measure is only an operation. The purpose of the operation is to artificially create an anus in the baby. When making a diagnosis full form atresia surgery is performed as soon as possible after birth, that is, on the first - second day.

The operation is carried out under local anesthesia . Stages of the operation:

1. The location of the rectum is determined and its blind segment is opened.
2. The original feces are removed.
3. The skin and edges of the intestinal incision are connected and sutured.

After the operation, a long rehabilitation course is required..

In addition, in the case surgical intervention with a critical form of the anomaly, an additional operation is necessary, but it is performed only after a year.

An additional operation is necessary for plasty in the perineum and peritoneum.

At the end of surgical treatment, the patient is prescribed a course of therapy aimed at reducing the size of the anal canal. For this purpose, within three months after the operation, special instruments are inserted into the anal canal to help expand the anus and rectum.

In the presence of a wide fistula size early operations carried out in exceptional cases. In such a situation, the normal passage of the intestine is stabilized. For this, a strict diet is prescribed, sufficient fluid intake, enema procedures.

With atresia, it is quite difficult to insert the tip of the enema into the anus, so thin catheters are often used to enter the intestines with water. With proper observance of all necessary recommendations the development of the baby is at the proper level. In this case, the operation is prescribed when they reach the age of two.

In the case of a wide fistula, the goal of the operation is to eliminate the fistula and form a normal anus.

During pregnancy during ultrasound examination can detect congenital atresia of the anus in the fetus in rare cases. For future mother to see a photo of a child born without an anus is a shock. But you should not immediately panic and have an abortion, because “forewarned is forearmed”, which means that in the hands of a woman is not only the birth of a baby, but also the possibility of saving him from death in the first days after birth.

Postoperative prognosis

An important factor for further development and the normal viability of the baby is the transfer of surgery.

Otherwise, death may occur 3 to 5 days after birth..

Even a high-quality surgical process does not 100% certainty in a favorable outcome.

But still a lot depends on the qualifications and experience of the surgeon, the equipment of the clinic modern equipment, first class preparatory process to surgery and careful postoperative care.

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Conclusion

It is impossible to delay the treatment of the disease. To achieve an unsurpassed effect from the operation, the doctor must perform it perfectly the first time. It has been proven that each subsequent operation that corrects a poor-quality approach to the initial one has a disappointing prognosis.

It remains to believe in the best and fully trust the recommendations and instructions of doctors if the child has such pathological problems.