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 2-year-old male infant was diagnosed with Hirschsprung disease in the newborn period. A transanal Soave pull-through was performed at 3 months of age. The child presented for evaluation following recurrent episodes of Hirschsprung-associated enterocolitis (HAEC) at the age of 18 months. On digital examination, the boy was found to have a circumferential rubbery ring along the hollow of the sacrum consistent with a Soave cuff. The abdominal x-ray shows an impacted colon, full of formed stool. This patient was managed with Botox injection into the external sphincter to help reduce anal spasms, which are thought to contribute to failure to evacuate stool in those under 2 years of age. After one year no further episodes of HAEC occurred.
