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 newborn infant with confirmed Hirschsprung disease on suction rectal biopsy. The child had been managed at home with rectal irrigations and had been clinically well. At the time of the elective laparoscopic pull-through procedure, turbid fluid was found in the right upper quadrant. The abdominal x-ray shows that there appears to be some dilation of the transverse colon and incomplete decompression despite rectal irrigations. The bowel was mapped with multiple full-thickness colonic biopsies in order to identify the normal ganglionated bowel and to aid in the preoperative planning for the definitive pull-through procedure. The child subsequently underwent a pull-through procedure and the transition zone was found to be in the descending colon.
