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 case study of a 3-year-old girl who has had a previous operation to repair an anorectal malformation with a rectovestibular fistula. The anus is posteriorly mislocated outside the muscle complex, which will contribute to her inability to potty train, and she requires redo surgery. Her continence potential is reduced by the fact that she has a history of tethered cord and her sacral ratio is 0.43. She is likely to require enemas to achieve social fecal continence (rectal or antegrade). In future, she may be able to transition to laxatives, as once her anus is properly located within the sphincter mechanism, only then can she realize her continence potential.
