American Medical Association Family Medical Guide - American Medical Association [183]
Hirschsprung’s disease
Hirschsprung’s disease (sometimes called congenital megacolon) is a rare birth defect in which segments of the lower parts of the large intestine, including the rectum, have no nerve cells to transmit the impulses that stimulate the contractions necessary to move food and waste through the intestines. The defect is more common in boys than in girls and tends to run in families. The main symptom of the disorder is severe constipation.
Other symptoms include a swollen abdomen, gas, abdominal pain, vomiting, poor appetite, and anemia (see page 610). To treat Hirschsprung’s disease, surgery is performed to remove the affected part of the intestine and join the healthy sections.
Imperforate anus
Imperforate anus is a birth defect in which the anal canal (the final section of the digestive tract) is closed, either by a membrane stretching across the canal or, in rare cases, because the digestive tract ends at the rectum, with no connection between the rectum and the anus. Imperforate anus is suspected if the baby has not passed meconium (the first bowel movement of a newborn) within 24 hours of birth. The diagnosis is confirmed if a finger or catheter inserted into the anus meets a blockage (the end of the rectum) or if the anal opening is absent. To treat imperforate anus, surgery is performed to remove the membrane or to open the end of the rectum and connect it to the anus.
Diaphragmatic hernia
In diaphragmatic hernia, an infant is born with an opening in the diaphragm (the large sheet of muscle that separates the chest from the abdomen and plays a major role in breathing). Part of the liver, spleen, or stomach or part of the large and small intestines may protrude through the opening into the chest and press on one of the lungs (usually the left lung), causing breathing difficulties. In severe cases, the baby’s skin may turn blue (cyanosis) from lack of oxygen and the baby may be placed on a ventilator to assist with breathing until surgery is performed.
Surgery (which is done as soon as possible) involves opening the chest and pushing the protruding organs back into the abdominal cavity and stitching up the diaphragm. Many infants with a diaphragmatic hernia die before or after surgery because their lungs are significantly underdeveloped and they cannot breathe, even with assistance from a ventilator. After surgery, the infant may be placed on a heart-lung machine, which removes carbon dioxide from the blood and supplies adequate oxygen. This procedure enables the diaphragm to rest and heal and improves the infant’s chances of survival.
Surgical adhesions
After abdominal surgery, scar tissue called adhesions may form in the abdomen and bind segments of the intestines together, causing an obstruction. The symptoms of surgical adhesions include abdominal swelling, cramping, and pain. The usual treatment for adhesions is surgery to cut the scar tissue to release the segments of intestine that are bound together.
Paralytic ileus
After an infection or surgery, the intestine can become paralyzed, losing its ability to move waste to the rectum. The intestine becomes stretched as it fills with fluid, waste, and air, causing inflammation and pain in the abdomen. Paralytic ileus can lead to fecal impaction, in which hardened stool becomes lodged in the intestine. To treat paralytic ileus, the doctor inserts a flexible tube through the child’s nose and down into his or her intestine to remove fluid, waste, and air. The child is given nothing by mouth and is fed intravenously (through a vein) until gas or stool is passed and intestinal function returns to normal.
Esophageal Atresia
Esophageal atresia is a rare birth defect that interferes with an infant’s ability to eat and breathe. In esophageal atresia, the part of the esophagus that leads from the mouth is not fully developed and does not reach