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 girl with total colonic Hirschsprung disease and she has had a pull-through procedure performed at 12 months of age. She is having difficulties with constipation and postoperatively has had episodes of enterocolitis. Staple lines in the pelvis in a child with a history of Hirschsprung disease on abdominal x-ray would suggest that the original procedure was a Duhamel pull-through. There is marked fecal loading in the Duhamel pouch, which is failing to empty. In children with a Duhamel pull-through, it is important to exclude a Duhamel spur. Excision of the spur with stapler or removal of the pouch and conversion to an ileoanal pull-through are two options for treatment.
