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 girl who is known to have undergone a primary posterior sagittal anorectoplasty (PSARP) as an infant for an anorectal malformation. She has no scars on the abdomen to suggest that she has had a previous colostomy and you therefore suspect that her original malformation was a perineal fistula or a vestibular fistula. The management this child require includes: redo primary posterior sagittal anorectoplasty, vaginal replacement, resection of pre-sacral mass and detethering of the spinal cord, intermittent catheterization to protect upper renal tracts and consideration for Mitrofanoff procedure and appendicostomy for bowel management given poor sacrum and tethered cord, and reduced capacity for voluntary bowel movements.
