Fistulas and atresias and surgery, oh my!

So I'm learning about all kinds of cool (but sad) defects that can occur when there are failures in embryonic development--things that don't close that are supposed to close, things that close when they aren't supposed to, or close in the wrong place...

Considering all the things that can go wrong, as I've said before, it's a miracle any of us make it. There are duodenal atresias, where the intestines just stop (ending in a pouch) after the stomach...obviously, that's life-threatening; there are fistulas (ie, communicating tracts that shouldn't be there) between trachea and esophagus sometimes, which means you can get air in your gut where it shouldn't be (not that big of a problem) or food in your lungs where it shouldn't be (obviously a much bigger problem).

Then there are all the fistulas and atresias (atresia=something isn't there, or is blocked off) associated with the, ahem, genital and rectal region. I'll just say that the picture of a recto-vaginal fistula that I saw in lecture today is something that will probably be with me for a long time, haunting my dark moments. There's also something called imperforate anus, which is exactly what it sounds like: no anus. Just born without one. The large intestine doesn't go all the way down. I don't know why, but those were particularly 'what the hell?' pictures for me too--I mean, you hear all the time of people having heart defects, or spina bifida, or whatever, but no anus? I mean, c'mon, Mother Nature, quit having those three-martini lunches and get with the program here. There's a fairly standard design for a human body. Let's stick to it and not be adding or subtracting ESSENTIAL parts, shall we?

There's also something called gastroschisis (which I probably misspelled--Google it and check on me, since my brain is so full of anatomy right now that I don't have room for petty things like spelling or grammar) where a baby is born with intestines outside the body wall. Just hanging out there, chillin, as if they were on the front stoop with forties and cigs. And what's the solution, you ask? It's so simple I didn't believe it at first, but the pediatric surgeon said: "You just keep them in the hospital a few days, keep the intestines enclosed in a plastic bag so they're moist and protected from bacteria, and then roll the bag down like a tube of toothpaste." Like a tube of toothpaste, I swear to Goddess that's what he said. And gradually the body wall expands to encompass the intestines, and they all fit in there eventually, and the kid gets sewn up and gets a surgically-made belly button and everyone's happy. It really is amazing that after a period of a few weeks what were these tremendous, striking abnormalities could be almost completely resolved...that's the appeal of surgery, I guess: quick fixes. You do something, and you immediately see results. The inflamed appendix is gone and the patient recovers. The intestines go into the body wall, the blocked artery gets bypassed, the compound fracture is reduced and set. Psychiatry is on the complete opposite end of the spectrum, but somehow I think it's edifying in a different way. After seeing those pre-and post-surgery pics, though, I guess I understand a bit more why surgeons rag on psychiatrists. Of course, then the psychiatrists get to retort with hypotheses about God complexes and sublimated hostility and aggression. So everyone has fun.