● Be alert to defecation more than two days after birth. The first two months after birth are the most dangerous
● "Red fart" can also cause defecation disorders
Medical guidance/Wu Qiang, deputy chief physician of pediatric general surgery in Guangzhou Women and Children's Medical Center
The new baby's eating, drinking and lazing all affect the new parents' hearts. If the baby discharges fetal stool more than two days after birth, it will cause vigilance. Wu Qiang, Deputy Chief Physician of Pediatric General Surgery of Guangzhou Women and Children's Medical Center, said that Hirschsprung's disease is a common neonatal digestive tract malformation, and the hospital will operate on about 200 children every year. Congenital megacolon is most dangerous in the first two months after birth, and most complications occur in this stage. However, because some lesions are not typical in the early stage of birth, and the examination results are ambiguous, it is generally recommended to relieve the condition in the early stage of birth, and operate around half a year old. He also reminded parents that the baby's intestinal function is not perfect and is vulnerable to external interference. Occasionally, it is normal to have less bowel movement and a slightly swollen stomach. As long as you can resume normal defecation after a bowel movement, you don't need to worry too much.
Common digestive tract malformations
More boys than girls
Congenital megacolon is one of the most common digestive tract malformations in neonates. It is about the second and third place in digestive tract malformations, and there is one case in every 5000 neonates. The ratio of male and female children was 4:1.
Under normal circumstances, when the ganglion cells on the wall of the intestinal canal feel that there is stool coming, they will reflect the signal to the brain, which will send a signal to make the anal sphincter contract and complete defecation. In children with Hirschsprung's disease, there are no ganglion cells on the wall of a section of intestinal tube with pathological changes, which leads to continuous spasm of the intestinal tube and functional intestinal obstruction. The interruption of the anorectal reflex ring cannot induce rectal contraction and relaxation of the internal sphincter, leading to loss of bowel movement and constipation. The stool coming from the upper part of the diseased intestinal tube is difficult to pass through the diseased intestinal tube, and it is silted up above the diseased intestinal tube. In order to "transport" the stool downward, the normal intestinal tube above the diseased intestinal tube will gradually expand, and then the intestinal wall will appear compensatory thickening and thickening, forming a huge expanded intestinal segment. "In fact, the primary lesion of Hirschsprung's disease is not in the dilated and hypertrophic intestinal segment, but in the narrow intestinal segment," Wu Qiang pointed out.
Most dangerous within two months after birth
Wu Qiang reminded that normal newborns will have dark green fetal stool discharged 24 to 48 hours after birth. If not, parents should be alert. Most children with Hirschsprung's disease develop abdominal distention and vomiting within 1 to 2 weeks after birth. The upper abdomen will become more and more distended, and the position of the navel will seem to move downward. The child cannot defecate by himself. When the abdominal pressure is too high, it may "squeeze" out some. The symptoms of constipation can be relieved through anal digital diagnosis and bowel washing. Affected by the disease, children will suffer from malnutrition, slow weight growth and weight loss.
According to Wu Qiang, the most dangerous stage of Hirschsprung's disease is the first two months after birth. Most of the complications occur at this stage, mainly including intestinal obstruction, enterocolitis, intestinal perforation and peritonitis. Among them, enterocolitis is the most common and the most serious, which is characterized by high fever, diarrhea, rapid signs of severe dehydration, high abdominal distention, respiratory distress and poisoning caused by extreme inflation and expansion of the small intestine and colon. The mortality rate is extremely high, also known as megacolon crisis.
Children entering infancy and childhood will still suffer from recurrent constipation, and abdominal distension will increase progressively. There will also be growth retardation and malnutrition.
Wu Qiang introduced that digital anal examination, barium enema, anorectal manometry, rectal biopsy, etc. can be used to assist in the diagnosis of Hirschsprung's disease. Barium enema can detect more than 90% of Hirschsprung's disease, and non-invasive anorectal manometry is also of great significance in determining the diagnosis.
treatment:
Half a year old is the best time for surgery
Congenital megacolon should be differentiated from many diseases. Similar symptoms may occur, including meconium constipation, which can be alleviated after a bowel wash; Newborn peritonitis can return to normal defecation after anti-inflammatory treatment; Thyroid function is low, and the baby will be quiet at the same time; Megacolon borderline disease, such as intestinal neuronal dysplasia; The anorectal reflex disappeared, but there were ganglion cells. Barium enema generally had no typical megacolon changes.
Wu Qiang said that some diseases were not typical in the early stage of life, and the examination results were ambiguous. Therefore, it was generally recommended to relieve the disease in the early stage of life by means of intestinal lavage and catharsis, and if necessary, laxatives. When nutritional status was improved, infection was controlled, and weight was increased, half a year old or so was the best time to operate on Hirschsprung's disease.
It is understood that the radical operation of congenital megacolon can achieve no wound on the abdominal cavity. The principle is to drag the diseased intestinal segment out of the body, remove the intestinal segment without ganglion cells and the proximal colon with obvious expansion of hypertrophic intestinal segment and ganglionic degeneration, so as to reduce the risk of abdominal infection. In case of severe enterocolitis or long segment megacolon, temporary enterostomy should be performed before radical operation, so as to drain the accumulated stool, remove toxins and resume eating.
For a period of time after radical surgery, babies tend to have diarrhea, weak intestinal resistance, and are prone to enteritis. Gradually, the stool will change from water to paste. Two or three weeks after the operation, the parents should start to expand the anus for the child until the scar period has passed, so as to avoid re narrowing. Although the operation removed a section of large intestine, the last section of small intestine will gradually replace the function of large intestine, and the child can achieve normal life in the future.
Reminder:
"Red fart" can also cause dysdefecation
Some parents are nervous when they see their children's tummy bulge or stool shortage. Wu Qiang said that in general, newborn babies defecate two or three times a day, but the baby's intestinal function is not perfect, and it is easy to be disturbed by the outside world. It is also normal that the defecation is reduced and the belly is slightly distended. If there is farting, it means that there is defecation reflex. If the stool is hard, you can use Kaisilu to assist in defecation. Normal defecation can be resumed after a defecation, so there is no need to worry. If you are repeatedly constipated, your stomach is getting more and more distended, and at the same time you are emaciated, mentally ill, and pale, you should be alert.
It is worth noting that sometimes the diapers are tightly wrapped and become "red farts", causing perianal infection. The baby feels pain in defecation, which may also cause defecation disorders. Therefore, every time the baby defecates, parents should pay attention to nursing to keep the buttocks clean and dry. Article/Guangzhou Daily reporter Wu Ren Correspondent Yi Minmin and Liang Shimin
