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-month-old male infant with an anorectal malformation who was diverted at birth with a colostomy and mucous fistula. It shows the distal loop colostogram. In this case, there was no real loop to the sigmoid noted when the colostomy was fashioned in the immediate newborn period. Ideally, the surgeon should have recognized this anatomical finding and fashioned the stoma more proximally (e.g., descending colon or even transverse colon, even though this is not the usual approach that is taught) in order to avoid the extremely short mucous fistula, which cannot be utilized for the pull-through without an additional procedure.
