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 male infant with a recto-perineal fistula. A surgeon has performed a posterior sagittal anorectoplasty on a male infant with a recto-perineal fistula. They did not pass a urethral catheter at the start of the procedure. The following day, the nurses report that there is urine draining from around the anoplasty. Preoperatively, a urethral catheter should be inserted in all cases to assist in the identification and preservation of the urethra, and a meticulous anterior rectal wall dissection should be carried out. There are several options available to manage the urethral injury; however, the best option is probably to attempt to pass a cystoscope and a urethral catheter and also consider placing a suprapubic catheter.
