Congenital anal atresia

　　1. This should start with the development of the embryo. In the early stage of the embryo, the anal canal and rectum of the fetus have not been separated, and the rectum and bladder are connected together, forming a cavity called the cloaca. When the embryo develops to the seventh week, the mesoderm grows downward, separating the rectum from the urogenital sinus, with the rectum developing towards the perineum, and the urogenital sinus forming the bladder, urethra, or vagina. By the ninth week, the rectum extends downward, penetrates the pelvic membrane and anal membrane to connect with the primitive anus, forming the rectum and anal canal. At this stage, due to certain reasons, the pelvic diaphragm or anal diaphragm cannot be penetrated by the rectum, resulting in congenital anal atresia. Such infants do not have an anus and are usually referred to as imperforate anus.

　　2. Congenital anal atresia is a common anal malformation disease.

　　3. If the rectum and urogenital sinus are not separated, congenital rectourethral fistula or rectovaginal fistula may form. Anal atresia often occurs with rectourethral fistula and rectovaginal fistula.

　　4. Currently, the etiology is unknown. The incidence rate is 1 in 4000.

　　The child may have concurrent rectourethral fistula or rectovaginal fistula, and feces may be excreted through the urethra or vagina. Such newborns will not die. However, if the abnormal excretion of feces is not noticed, and there is too much feces retained in the urethra or vagina, it can cause cystitis, pyelonephritis, vaginitis, and other conditions.

　　1. The main manifestations of this disease are the absence of meconium excretion after birth of infants, crying and restlessness, abdominal distension, vomiting, and the absence of the anus. Some children may have concurrent rectourethral fistula and rectovaginal fistula, in addition to the above symptoms, meconium may be excreted through the urethra or vagina, and urine may become turbid.

　　2. The diagnosis of this disease is mainly based on the fact that the perineum will bulge or indent with the increase or decrease of abdominal pressure during crying. By gently pressing the lower abdomen with one hand and touching the perineum with the other, a sense of fluctuation can be felt. If the child's buttocks are elevated, a tympanic sound can be heard when percussing the anal area. X-ray can help further confirm the diagnosis.

　　3. Newborns with congenital anal atresia do not excrete meconium after birth. After feeding, the abdomen swells, vomiting occurs, followed by dry and emaciated skin, and weight loss. If such symptoms occur, one should consider anal atresia. If not discovered and treated in time, it may easily lead to intestinal obstruction, intestinal necrosis, and neonatal death.

　　4. If the child has concurrent rectourethral fistula or rectovaginal fistula, feces may be excreted through the urethra or vagina. Such newborns will not die. However, if the abnormal excretion of feces is not noticed, and there is too much feces retained in the urethra or vagina, it can cause cystitis, pyelonephritis, vaginitis, and other conditions.

　　5. If the child has congenital anal-rectal stenosis, it may manifest as obstinate constipation, pain during defecation, crying, extremely thin stool, small amount, abdominal distension, poor digestion, and weight loss.

　　6. Neonatal anal atresia is often overlooked. Therefore, after the birth of a newborn, a comprehensive physical examination should be conducted, and attention should be paid to the observation of defecation to prevent neonatal death.

　　Congenital anal atresia is an innate disease with unknown etiology and unclear pathogenesis. There are currently no effective preventive measures. Early detection, early diagnosis, and early treatment can prevent the occurrence of complications.

　　The main manifestations of this disease are the absence of meconium excretion after birth of infants, crying and restlessness, abdominal distension, vomiting, and the absence of the anus. Some children may have concurrent rectourethral fistula and rectovaginal fistula, in addition to the above symptoms, meconium may be excreted through the urethra or vagina, and urine may become turbid. At the same time, the diagnosis should be made in combination with the following examination results.
　　1. Rectal examination.
　　2. Ultrasound.
　　3. Puncture.

　　Firstly, fasting should be avoided early after surgery.

　　1. Consume liquid or soft foods.

　　2. Consume foods rich in collagen.

　　Secondly, avoid foods that promote disease.

　　1. Avoid spicy and刺激性 foods.

　　2. Avoid greasy and fried foods.

　　1. The main treatment for this disease is surgery. If only the anal membrane is covered, it can be performed by anterior and posterior longitudinal incisions or cross incisions, and the film is cut off, and then the anal canal is expanded with the index finger. If there is a fibrous band, it can be excised; if the anal membrane is thick, the skin and rectum can be incised, and the rectal mucosa is subtracted and sutured with the skin. After surgery, anal dilation is performed twice or three times a week until the anal stenosis is relieved.

　　2. Since anal atresia is caused by congenital maldevelopment of the rectum and anus, after birth, artificial anus is made through surgery, and the local anal sphincter will not be as healthy as that of a normal person, or the sphincter will be weak and powerless, or the sphincter will be missing. Therefore, most children after surgery will have anal stenosis at the same time, accompanied by fecal incontinence, especially uncontrollable loose stools, and there will often be fecal pollution of the underwear. In addition, since the rectal mucosa is directly sutured with the anal skin during surgery without a segment of 'anus', it often accompanies the inversion of the intestinal mucosa. After the inverted intestinal mucosa is rubbed and polluted by feces, it will cause an inflammatory reaction, with mucous and bloody stools, and the perianal skin may appear eczema. Therefore, such children must be washed and changed frequently in daily care, and actively treated for their complications. The treatment of congenital anal atresia is mainly surgery.

　　3. The second method is to make an artificial anus in the abdomen first, and then perform rectal anal anastomosis in the abdominal or sacral tail after the child grows to 1-2 years old.

　　4. The third method is to treat anal stenosis with automatic intermittent electromagnetic attraction. That is, after the sigmoid colon stoma (i.e., artificial anus) is made, an appropriate cylindrical iron block (diameter of about 0.5 cm) is sent into the rectal blind segment, and then the intermittent magnetic attraction device is used to attract at the external anal orifice, so that the rectum gradually descends from a high position to a low position. Then, low-position incision analplasty is performed. This method has less trauma, fewer complications, and fewer postoperative sequelae such as anal incontinence.

　　5. As long as the treatment is timely and effective, anal stenosis generally will not lead to neonatal death.