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 the patients who had undergone previous surgery to repair an anorectal malformation. It considers the postoperative images and focuses on clinical examination. The urethra and the vagina appear normal. The perineal body is not adequate and the anus is too narrow. The anus is stenotic and not well centered within the sphincter complex. There is no posterior sagittal incision from previous surgery, suggesting that this incision was not used. There may, therefore have been previous inadequate mobilization of the anterior rectum from the posterior wall of the vagina at the original operation. There is a remnant of the rectovestibular fistula i.e., the original distal rectum was left behind when a more proximal segment of rectum was mobilized for the anoplasty.
