1.Why does constipation still occur after congenital megacolon surgery? A: There are many factors of constipation after megacolon surgery, the most common reason is the residual ganglion cell-free lesion segment, in a few cases, the residual lesion segment is due to incomplete surgical resection, which is rare under the current technical conditions, and the majority of the cases are the secondary necrosis of the ganglion in the distal rectum due to infection or ischemia, which leads to the absence of the ganglion cells, and the presence of the lesion segment affects the function of anorectum, so constipation is likely to occur. The presence of a diseased segment of bowel affects the function of the anorectum and therefore constipation is likely to occur. In addition, if the rectus muscle sheath retained during surgery is too long or too tight, it is also an important cause of postoperative spasm of the sphincter and delayed defecation. The sphincter muscle cannot reflexively relax during defecation, thus constipation. The last is that many patients with megacolon are combined with abnormal power function of proximal colon, even though surgical resection of distal diseased intestines, but the power disorder of proximal intestines has not been relieved, so they are also prone to constipation after surgery. Other rare causes include excessive pelvic floor injury, severe scar tissue around the rectum, abnormal rectal compliance, abnormal sensation of rectal mucosa, etc. All these causes may lead to postoperative constipation. 2.Does postoperative constipation require a second surgery? Is it effective to continue enema? A: Not all postoperative constipation requires a second operation. For postoperative constipation, the first thing to do is to find out the cause of constipation, if there is a clear lesion of intestinal segments remaining, then a second operation must be performed, whereas if constipation is caused by other functional reasons, then surgery is not recommended. Regardless of the cause of constipation, enema treatment is an effective treatment method, some functional causes of constipation, enema can play a role in curing, even for the residual lesions caused by constipation, enema is still the most effective way to relieve the symptoms, especially the whole gastrointestinal tract dysfunction cases, enema is currently the only effective way to relieve the symptoms. 3.Why do some children have diarrhea after surgery? How to deal with it? Answer: short-term postoperative diarrhea (within 1 year, up to 3 years) is mechanical, and intestinal resection, due to the main function of the colon is to absorb water and storage of feces, due to the surgery to remove part of the intestinal tube, resulting in a reduction in the absorption of water in the colon, and intestinal shortening, and therefore prone to diarrhea; the treatment of the main relief of symptoms, mainly with some protection of the mucosa of the gastrointestinal tract, regulating the intestinal microecology of drugs. The treatment is mainly to relieve the symptoms, mainly using some drugs to protect the gastrointestinal mucosa and regulate the microecology of the intestine. For the postoperative diarrhea in the distant future, most of them are megacolon associated enteritis, i.e. small bowel colitis, the pathogenesis of megacolon associated enteritis is not very clear at present, it may be related to the presence of distal functional obstruction or intestinal mucosal barrier destruction and impaired intestinal immune function, treatment must pay attention to the need for laxative cleansing and metronidazole retention of the enema effect is obvious, and at the same time, strengthen the systemic nutritional support! At the same time, strengthen the systemic nutritional support, intravenous infusion of metronidazole anti-inflammatory. If there is a combination of dehydration or severe anemia malnutrition, all need to be corrected at the same time. For example, blood transfusion, gammaglobulin and total intravenous nutrition. 4.How long does the diarrhea last and how long do I need to be alerted to small bowel colitis? Is it necessary to consult a doctor immediately? A: For diarrhea that occurs in the near future (within 1 year), mechanical diarrhea should be considered. If the diarrhea is not relieved according to common treatment methods, and at the same time, there are systemic symptoms, such as fever, abdominal distension, foul-smelling bowel movements, etc., no matter how long the diarrhea lasts, small bowel colitis should be considered, and it is necessary to treat it according to small bowel colitis and pay attention to the nutritional support. In the past, the morbidity and mortality rate of small bowel colitis is very high, is the main cause of death of megacolon, with the application of broad-spectrum antibiotics and the development of total intravenous nutritional technology, as well as other nutritional support therapy, the morbidity and mortality rate of small bowel colitis has been significantly reduced, but still should not be ignored, once suspected small bowel colitis should be hospitalized as soon as possible, early diagnosis and early treatment, so as not to delay the condition. 5.What causes postoperative diarrhea and blood in stool? How to treat it? A: Most of the postoperative diarrhea and bloody stools after megacolon surgery are caused by increased vascular permeability of the intestinal mucosa and extravasation of blood cells due to enteritis, while a few are caused by prolonged diarrhea, alkaline intestinal fluid corrosion of the perianal skin leading to skin and mucous membrane bleeding, and a few cases are anastomotic hemorrhage. For diarrhea caused by bloody stool or mucosal bleeding is mainly the treatment of diarrhea, relieve symptoms, protect the intestinal mucosa, protect the perianal skin, you can apply a variety of ointments or light bulb illumination, keep the perianal skin dry; for anastomotic bleeding to immediately fasting water, active treatment of diarrhea, if conservative treatment is ineffective, then the need for proximal colostomy, fecal diversion. 6, postoperative bloating for anal expansion, stool thin and acid is normal? A: To analyze each case, if the postoperative bloating, only anal spasm caused by bloating expansion will be relieved, expansion can be a small amount of dilute stool, but if the stool is watery and accompanied by fever or fecal odor should be considered small bowel colitis, early treatment. For intestinal adhesion or indigestion or intestinal dyskinesia caused by abdominal distension, anal dilatation is not very helpful, and occasionally there will be a small amount of loose stools, in this case, it is necessary to use a little bit of gastrointestinal dynamics of drugs. 7.After the operation, there is fecal incontinence, often a small amount of feces stained underwear, how is it? What should I do? A: Complete fecal incontinence rarely occurs after megacolon surgery, but often a small amount of fecal matter contaminates the underwear. This phenomenon has a proprietary term in medicine, which is called “dirty stool” or “dirty feces”, the cause of this phenomenon is not clear at present, and it may be related to the dysfunction of the internal sphincter muscle, and other reasons, such as abnormal sensation of the mucosa of the rectum and decrease in the compliance of the rectum, etc., can also lead to the occurrence of dirty feces. There have been a large number of case reports confirming that pelvic floor biofeedback training and sacral nerve electrical stimulation is an effective treatment for defecation and urination disorders. In China, Shengjing Hospital of China Medical University has taken the lead in applying this technology to treat defecation disorders after megacolon and anorectal malformations, and has achieved satisfactory results, with a wealth of clinical experience, and a leading therapeutic level in China. The advantages of this method are simplicity, non-invasiveness, and exact efficacy, which is worth popularizing.