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 5-year-old child who has had a previous pull-through procedure and presents with a history of constipation and soiling. There are regular episodes of distension and since surgery have been three episodes of enterocolitis. Botox of the anal canal has been done several times with no improvement. This child requires a redo procedure for a retained transition zone and obstructive symptoms. The redo of the pull-through needs to reach to healthy colon with both normal ganglion cells and normal size nerves. The additional concern in this child, however, is the damage to the dentate line, which is likely to impair his potential for future fecal continence, and he may require a cecostomy/ACE/Malone to be socially clean.
