Male1: What if babies are born and the pediatrician notices that the kid did not make a bowel movement. He looks at the rectum and puts his finger up there, it does not pass and tells the parents we have got a little bit of a problem. What is that problem called?
Male2: You can do a rectal exam. It sounds like there is a little stenosis or a little narrowing.
Male1: Narrowing and an imperforated anus. How would you as a surgeon want to approach the problem and how can we get the situation so that it can function down the road?
Male2: If the baby is not able to pass any air or stool at all, it is an emergency because the bowels would get very swollen and the baby would be vomiting and they could not get any nutrition, so that needs some sort of emergency procedure, that baby needs to be in the hands of a team with pediatric anesthesiologist, pathologist, an NICU and a surgeon. As often as not, the first operation a baby would get would be to bring the bowels out to an appliance called a stoma.
Male1: In other words, give a way to get some of that build up of stool outside.
Male2: Yes, it is a wonderful method to relieve the obstruction, it does not bother the baby a bit. It gets the parents a little upset that the baby does have not stool and then into a diaper but it relieves the obstruction and it allows them to be—
Male1: So we are going to do is to fix in stages, correct?
Male2: If a baby cannot pass any stool at all, that would usually be the case, yes.
Male1: Okay, the first approach is you said, a way of getting some of it out. So that is a little hole to bring the stool outside and they put a bag on and they collect the stool externally that way.
Male2: Yes sir.
Male1: But down the road, what is your approach on a baby.
Male2: Let us see, availability of good imagers. The pediatric radiologist, you look for other malformations. If God made a little misstep in creating the anal rectal area, you want to check the heart, the kidneys, the spine, the other organs, the skeleton.
Male1: Most common other thing that you would find would be probably what?
Male2: Probably cardiac and urologic—the urinary system, the kidney, the bladder, the urethra, ten percent of the kids will have a blind ending esophagus, so there is a whole list that are all pretty common and you have got to look for them.
Male1: So it is a team approach, but if you got down to just that problem only, what would be if you are going to make things better, what could you do down the road?
Male2: When the baby was home, growing, thriving, you would schedule a plan.
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