ABSTRACT
This chapter explains the key principles in the management of complex pediatric colorectal diagnoses. It provides case-based presentations, radiographic images, operative images with Multiple Choice Questions to test knowledge. The chapter presents an overview of distal colostogram. The high-pressure colostogram is the most important radiologic examination to demonstrate the specific type of fistula, length of mucous fistula, the anatomic relationship of the fistula to the sacrum/coccyx, and the distance of the rectum to the expected position of the anus. Prior to beginning the procedure, the expected normal position of the anus is delineated with a radiopaque marker and a radiopaque ruler is placed under the patient for accurate measurements. A Foley catheter is inserted into the mucous fistula. Hand injection of an initial contrast bolus defines the length and relative diameter of the mucous fistula. The catheter is repositioned into a segment that is amenable to Foley balloon inflation, without the risk of perforation.
