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 patient who was diagnosed with Hirschsprung disease as a newborn infant. She underwent a laparoscopic-assisted transanal Soave pull-through. She did well following the pull-through; however, she has been experiencing problems with constipation for several years, despite medical therapy. More recently, she has been having episodes of enterocolitis requiring hospital admissions, and she is currently taking prophylactic antibiotics to reduce these episodes. The obstructive symptoms that this child has been experiencing after initially doing well post-Soave pull-through are characteristic of a Soave cuff causing a degree of obstruction. The child should also undergo an examination under anesthesia and rectal biopsy to confirm the diagnosis of a cuff by digital exam and exclude a transition zone pull-through. The cuff is palpable on rectal examination.
