Congenital Hirschsprung's disease is usually called Hirschsprung's disease because it is described in detail, because the intestine at the distal end of rectum or colon continues to spasm, and feces stagnate in the proximal colon, which makes the intestine thicken and expand.

Guiding opinions:

clinical picture

1. Children with delayed meconium discharge, intractable constipation and abdominal distension have different clinical manifestations due to different lengths of diseased intestines. The longer the spasm, the earlier and more serious the constipation symptoms. If there is no meconium discharge or only a small amount of meconium discharge within 48 hours after birth, symptoms of low partial or even complete intestinal obstruction may occur within 2 ~ 3 days, and vomiting and abdominal distension will not cause defecation. Spastic segment is not too old. After rectal digital examination or warm saline enema, a lot of meconium and gas can be discharged, and the symptoms are alleviated. The spastic segment is not too old, the symptoms of obstruction are not easy to relieve, and sometimes emergency surgery is needed. After the symptoms of intestinal obstruction are relieved, constipation and abdominal distension still exist, and anus should be dilated frequently before defecation. Severe cases develop into no enema and no defecation, and abdominal distension is gradually aggravated.

2. Malnutrition, stunted growth, long-term abdominal distension and constipation will reduce children's appetite and affect the absorption of nutrients. Fecal deposition can make the colon hypertrophy and expansion, and the abdomen can have a wide large intestine type, sometimes touching the intestinal loop and fecal stones full of feces.

3. Congenital Hirschsprung's disease with enterocolitis is the most common and serious complication, especially in the neonatal period. The cause is not clear. It is generally believed that the obstruction in the past few days, hypertrophy and dilatation of the proximal colon and poor circulation of the intestinal wall are the basic reasons. On this basis, some children have enterocolitis due to abnormal immune function or allergic constitution. Others believe that it is caused by bacterial and viral infections. However, no pathogenic bacteria grow in fecal culture. Colon is the main affected site, with mucosal edema, ulcer and local necrosis. After inflammation invades the muscular layer, it can be manifested as serosa congestion and edema, and there is exudation in the abdominal cavity, leading to exudative peritonitis. The child's whole body doubts suddenly worsen, abdominal distension is severe, vomiting sometimes diarrhea, and dehydration acidosis, high fever, rapid fat loss and blood pressure drop are caused by diarrhea and the accumulation of a large amount of intestinal fluid in the enlarged intestine. If not treated in time, it will lead to higher mortality.

Life care:

For those with short spastic bowel segments and mild constipation symptoms, comprehensive non-surgical treatment can be taken first, including regular isotonic saline intestinal lavage (the amount of intestinal lavage is equal, hypertonic saline or soapy water is prohibited), anal dilatation, glycerol suppository and laxative, and acupuncture or Chinese medicine can be used to prevent feces from accumulating in the colon. If the above methods fail, short-segment Hirschsprung's disease should also be treated surgically.

If the bowel spasm lasts for a long time and constipation is serious, radical surgery must be performed. At present, the most commonly used operation is ① Swenson's sigmoidectomy. S operation); ② The colon was dragged out after colectomy (Duhamel? S surgery); ③ Stripping the rectal mucosa and pulling the colon out of the rectal muscle sheath (Soave? S operation). If the child suffers from acute enterocolitis, crisis or nutritional development disorder and cannot tolerate radical surgery, intravenous fluid infusion and blood transfusion should be performed, and radical surgery should be performed after the general condition improves. If enteritis is uncontrollable, abdominal distension and vomiting persist, enterostomy should be performed in time, and radical surgery should be performed later.