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 boy who was born with an anorectal malformation and spina bifida occulta. The anorectal malformation (perineal fistula) was repaired in the newborn period. He developed severe constipation at the age of 2 years, which did not respond to high doses of laxatives. At the age of 4 years he had a cecostomy placed. His original anorectal malformation carries a good prognosis for bowel control and he has had a good anatomical repair, normal spine, and a "medium" sacral ratio. His dilated rectosigmoid likely relates to inadequate management of his constipation when he was a toddler. He was entered into the bowel management program and the cecostomy flush was adjusted. He then continued to a laxative trial.
