What is congenital megacolon? The human intestinal tube is always in constant diastole and peristaltic contraction in order to transport its contents to the exit. The final control site is the ganglion under the intestinal mucosa. If the ganglion of the rectum is congenitally absent, the rectal part will not move like a lead pipe. As a result, fecal matter stays in the colon above the rectum and as a result, the colon expands like a balloon. Previously, it was named megacolon disease because only the dilated colon was seen. Etiology Persistent spasm of the rectum or distal colon and stagnation of feces in the proximal colon cause hypertrophy and dilatation of that section of the colon. Congenital megacolon, also known as anaplasia, is a condition in which the intestinal canal (mostly rectum and sigmoid colon) has no ganglion cells and is therefore in a state of spasticity and stenosis, resulting in loss of normal peristaltic and defecation functions. Congenital megacolon is one of the more common developmental malformations of the gastrointestinal tract in newborns, accounting for the second highest incidence of gastrointestinal malformations, with a prevalence of 1:2000 to 1:5000 in males and a familial tendency to develop, and its causes are not only related to genetic factors, but also to changes in the microenvironment of the intestinal wall during embryonic development. Symptoms Almost all normal newborns pass their first fetal stool within 24 hours after birth, and the first stool is excreted within 2~3 days. In children with congenital megacolon, because the intestinal canal is in a spastic and narrow state, fetal stool cannot be passed, so no fetal stool is excreted within 24~48 hours, or only a small amount is excreted, and more fetal stool is excreted only after treatment with soap bars or enemas. The symptoms of partial or even complete low-level intestinal obstruction usually appear within 2-6 days: vomiting, which may be infrequent and small in amount, but may also be frequent, with bile or fecal-like liquid in the vomit; distended belly, with full abdominal distension, some extremely distended and shiny belly. The symptoms are relieved by assisted laxation, but constipation, bloating, and vomiting reappear a few days later. In a few cases, after the first few days of intestinal obstruction in newborns, there may be a “remission period” of several weeks or even months, in which the child may have normal or small intervals of defecation, but then finally reappears with intractable constipation. As a result of recurrent episodes, children often do not gain weight. Complications such as small intestine colitis (with diarrhea), intestinal perforation, malnutrition, etc. may also occur and can lead to death in severe cases. Home treatment and treatment suggestions Home care: Helping the child to keep defecation is the focus Open plug and soap bar to stuff the anus is the most common means, poor results can be used to dilate the anus (finger or dilator), pay attention to the action should be gentle, and use liquid paraffin or other lubricating fluid. For babies with severe abdominal distension and constipation, regular enemas must be used to help defecate, and large amounts of warm saline should be used for enemas (equal amounts of irrigation in and out are required, avoid using hypertonic or hypotonic saline or soapy water). In a beer bottle of warm boiled water, put 1½ tablespoons of salt to obtain a solution similar to the concentration of saline (9 grams of salt dissolved in 1000 ml of distilled water). An enema with normal water can cause dehydration due to the osmotic pressure, and then shock is easily triggered. Treatment recommendations Surgery is usually required for congenital megacolon. Treatment for congenital megacolon includes non-surgical treatment, enterostomy, and radical surgery, and once diagnosed, radical megacolon surgery is usually required to cure it. For those with short spastic intestinal segments and mild constipation symptoms, comprehensive non-surgical treatment can be used, including regular bowel washings with isotonic saline, anal dilation, glycerin suppositories, laxatives, and acupuncture or Chinese herbal medicine to avoid the accumulation of feces in the colon. If the above methods are ineffective, surgery should be performed even if it is a short segment of megacolon. Enterostomy is suitable for those with complications of small intestine colitis, intestinal perforation or poor general nutritional status, which is a transitional treatment measure by surgically dragging the normal intestine out of the fixed abdominal wall to create a fistula, so that the stool can be discharged. After the operation, the child should be trained to defecate and the anus should be dilated regularly for 3 months under the guidance of the doctor to improve the long-term outcome. In recent years, the age of radical megacolon surgery has been advanced from 1~2 years old to 6 months after birth or even earlier, and there are more and more people performing stage I megacolon radical surgery in the neonatal period, which can avoid complications such as small bowel colitis and malnutrition, and has achieved a lot of results. The surgical approach has also changed from complicated to simple, i.e., from transabdominal-perineal to transanal surgery. At present, transanal megacolon radical surgery is gradually becoming a popular procedure because of its simplicity, short hospital stay, rapid postoperative recovery, and low complications. Early diagnosis to avoid serious complications If a newborn baby shows signs of delayed fecal discharge, abdominal distention, constipation, vomiting, etc., he or she should go to the pediatric surgery department of the hospital as early as possible to seek help from a specialist to determine whether he or she has congenital megacolon, as early diagnosis and early intervention are essential to avoid serious complications.