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 3-year-old male with anorectal malformation. The anatomy in this child is not optimal (mislocated anus with rectum outside of the sphincter mechanism) and he will not successfully potty train. The dilated distal colon occurred likely due to years of inadequate management of constipation. He will require a redo procedure in the future to maximize his potential for future bowel control, but it is potentially possible to keep him clean with an enema regimen as a "first step". The patient succeeded with the bowel management program with rectal enemas. He will undergo redo primary posterior sagittal anorectoplasty with Malone appendicostomy to correct the anatomy and provide a route for antegrade enemas.
