During the 6th to 12th week of embryonic development, viral infections, metabolic disorders, local blood flow disorders or genetic factors may cause neurodevelopmental arrest or ganglion cell degeneration, resulting in spasm and stenosis of the distal segment of the intestine without ganglion cells and dilatation of the proximal segment of the intestine to form megacolon. What are the clinical manifestations of neonatal megacolon? Acute intestinal obstruction occurs within 1-6 days after birth. (1) Delayed fetal excretion: 90% of cases have no fetal excretion at birth or only very little fetal excretion. After the fetal stool is passed, the symptoms are relieved, and then the constipation symptoms recur after a few days. (2) Abdominal distension: 80% of cases show full abdominal distension, and in severe abdominal distension, intestinal shape is visible in the abdomen. (3) Vomiting: 60% of cases showed vomiting and abdominal distension, and the more severe the constipation, the more frequent the vomiting. (4) Anal examination: Anal finger examination can reveal spasm of the internal rectal sphincter and hollow rectal jug abdomen. (5) Comorbidity: combined with colitis, intestinal perforation is the most serious comorbidity, the long-term retention of large amounts of feces in the colon of the sick child, poor circulation of the intestinal wall and caused by bacteria. In addition, the thin intestinal wall of newborns, the pressure in the intestinal cavity increases, and the part that bears the greatest pressure is easy to cause perforation. Neonatal megacolon examination 1, medical history and signs More than 90% of children born without fetal stool within 36 to 48 hours after the birth, that is, stubborn constipation and abdominal distension must be enema laxative or plug anal suppository to defecate history, often malnutrition, anemia and loss of appetite, abdomen highly distended, and visible wide intestinal type, rectal palpation feel rectal pot abdomen empty, there are blast-like exhaust defecation. 2.X-ray view: abdominal standing plain film mostly shows low colonic obstruction, barium enema lateral and anterior-posterior photos can be seen in the typical spastic intestinal segment and dilated intestinal segment, poor barium excretion function, 24 hours later there is still barium retention, if not timely enema wash out barium can form barium stone, combined with enteritis dilated intestinal segment intestinal wall is jagged performance. 3.Biopsy Take a small piece of tissue from the rectal wall submucosa and muscle layer more than 4cm from the anus, check the number of ganglion cells, lack of ganglion cells in children with megacolon 4.Anorectal manometry, measurement of reflex pressure changes in the rectum and anal sphincter can diagnose congenital megacolon and identify other causes of constipation, in normal children and functional constipation when the rectum is distended stimulation of the internal sphincter In normal children and functional constipation, when the rectum is stimulated by distension, the internal sphincter immediately undergoes reflex relaxation and pressure decreases, while in children with congenital megacolon, the internal sphincter does not relax but also undergoes significant contraction to increase the pressure. The amount and activity of both can be measured chemically 5 to 6 times higher than in normal children, which is helpful in the diagnosis of congenital megacolon and can be used in newborns. Treatment and care of neonatal megacolon The two common treatment options for neonatal megacolon are conservative therapy and surgical treatment. (1) Conservative treatment: Carefully take care of the child and make preparations for surgery. The purpose is to relieve the pain caused by abdominal distension and constipation, such as using anal dilation, warm saline cleansing bowel, taking laxative, maintaining water-electrolyte balance and nutrition. The anal canal should be inserted through the spastic section, so that the effect of bowel cleansing is satisfactory and the abdomen is flat and the muscles are relaxed. The child should be kept warm during intestinal lavage to prevent secondary pulmonary complications. (2) Surgical treatment: open or minimally invasive surgery. In 80% of our children, laparoscopic megacolon resection can be performed in one stage. (1) Colostomy. Colostomy is a way to overtake the megacolon crisis and then perform radical surgery at about 1 year of age. The indications are for children who are not suitable for first-stage radical surgery, such as poor general condition, and malnutrition. After the fistula, attention should be paid to protecting the skin around the fistula opening to be clean and dry, lying in a comfortable position, keeping warm, and feeding carefully. In recent years, the first-stage radical surgery has been used in the neonatal period with good results. Two weeks of preparation before surgery. This includes clean bowel washings, which are required until the abdomen is flat and soft, correction of malnutrition, and application of antimicrobial agents. There are different surgical procedures depending on the type of pathology, and laparoscopy completes the intra-abdominal operation.