ABSTRACT
This chapter explains the key principles in the management of complex pediatric colorectal diagnoses. It provides case-based presentations, radiographic images, and operative images with multiple choice questions to test knowledge. The chapter presents a case study of a newborn infant with Hirschsprung disease. The child was initially thought to have sigmoid disease based on the information provided by the contrast enema. The transition zone was thought to be in the sigmoid, and therefore the child's pull-through was approached transanally. Ganglionic bowel however could not be identified through the transanal approach and therefore the procedure was converted to laparoscopic. The bowel could not be mobilized laparoscopically because of excessive bowel distension and hence the child required a laparotomy. Clearly a laparoscopy first with confirmation of the transition zone should have been the first step. This is an excellent example of why starting transanal only is a potential pitfall.
