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 a long-term case study of a child born with an anorectal malformation and VACTERL association: Tracheo-esophageal fistula (TEF)/esophageal atresia (EA), Hydronephrosis, Lipoma of the spinal cord and Atrial septal defect. He was managed in the newborn period with repair of the TEF/EA and the anorectal malformation was managed with a colostomy and mucous fistula. The reason for performing the distal loop colostogram is to demonstrate the position of the distal rectum and fistula (if present). This is only achieved if a high-pressure study is performed. Clinically, the patient was showing features consistent with a tethered cord and is awaiting tethered cord release. Constipation has been a concern and he underwent evaluation for this to rule out the anatomical problems with the anoplasty.
