Imperforate Anus

∞ Obstructive Hydrocephalus or Intraventricular

Hydrocephalus= if there is block to passage
of fluid
∞ Is stricture of the anus ∞ Congenital Hydrocephalus= occurs at birth
∞ There may be accompanying fistula to the ∞ Acquired Hydrocephalus = occurs from an
bladder in boys and to the vagina in girls incident later in life
∞ It may occur as an additional complication
of the spinal cord disorders because both
the external canal and the spinal cord
arise from the same germ layer

Assessment
∞ No anus is present
∞ The condition may be revealed because a
membrane filled with black meconium can
be seen protruding from the anus. A wink
reflex (touching the skin near the rectum
should make it contract) will not be
present if sensory nerve endings in the
rectum are not intact
∞ Inability to insert a rubber catheter into the
rectum
∞ No stool will be passed and abdominal
distention become evident

Therapeutic Management
∞ Surgery – anastomosis of the separated
bowel segments

Hydrocephalus
Cerebrospinal Fluid (CSF) is formed in the first and
second ventricles of the brain and passes through
the aqueduct of Sylvius and the fourth ventricle to
empty into the subarachnoid space of the spinal cord
where it is absorbed
• It is an excess of CSF in the ventricles or the
Assessment
subarachnoid space
• If cranial sutures are not firmly knitted, this
excess fluid causes enlargement of the skull
∞
∞
Cause is unknown
Overproduction of fluid
∞ Obstruction of the passage of fluid
∞ Interference with the absorption of CSF
from the subarachnoid space if the portion
is removed
∞ Excessive fluid accumulates and dilates
the system above the point of obstruction
∞ The infant’s fontanels widen and appear
tense, the suture lines on the skull
separate and the head diameter enlarges
∞ The scalp becomes shiny and scalp veins
become prominent
∞ Brow bulges in a typical
appearance(bossing) and the eyes
become sunset

Signs of Increased
∞ Communicating Hydrocephalus or
Extraventricular Hydrocephalus =If fluid can
Intracranial Pressure such
reach the spinal cord as
 ∞ decreased pulse and respiration,
∞ increased temperature and blood
pressure,
∞ hyperactive reflexes,
∞ strabismus and optic atrophy
∞ Irritable or lethargic,
∞ fail to thrive
∞ High pitched cry
∞ All children under 2 years should have
their head circumference recorded
∞ Measure head circumference of all infants
within an hour of birth and before
discharge
∞ The infant’s motor function becomes
impaired as the head enlarges
Can be demonstrated by sonogram, Computed
Tomography, Magnetic Resonance Imaging
Transillumination (holding a bright light against the
skull with the child in the darkened room) revealed
the skull is filled with fluid
Therapeutic Management
∞ Overproduction of fluid= Acetazolamide
(Diamox) to promote excretion of fluid
∞ Obstruction = removal
∞ Laser surgery to reopen the route of flow
or bypassing the point of obstruction by
shunting the fluid to another point of
absorption

∞ Shunting Procedure involves threading a

thin polyethylene catheter under the skin
from the ventricles to the peritoneum.
∞ Fluid drains by this route into the
peritoneum and is absorbed by the
peritoneal membrane and into the body
circulation