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 radiology of a newborn with distal bowel obstruction. Near iso-osmolal contrast is the preferred initial contrast in infants with a presumptive diagnosis of distal bowel obstruction. The main differential diagnoses include: Hirschsprung disease, Neonatal small left colon, Ileal atresia, Meconium ileus and Meconium plug syndrome. The radiologic diagnosis of Hirschsprung disease is made with a contrast enema and the identification of a transition zone. A small-caliber catheter is placed in the rectum as close to the external sphincter as possible. The radiographic diagnosis of total colonic aganglionosis may be difficult given that the colon may have a normal appearance, pseudo-transition zone, or microcolon.
