ABSTRACT
This chapter explains the key principles in the management of complex pediatric colorectal diagnoses. It provides case-based presentations, radiographic images, and operative images with multiple choice questions to test knowledge. The chapter presents a case study of a child with known Hirschsprung disease who underwent an ileo-anal Duhamel pull-through in the newborn period. The child is 2 years old and is failing to thrive (5th centile for weight) and is having difficulty stooling, chronic abdominal distension, and has developed Hirschsprung-associated enterocolitis. Multiple Botox injections have been performed in the past without improvement. As per the clinical protocol for Hirschsprung disease, this patient is showing signs of an obstructive problem and all such patients require a contrast enema and an examination under anesthesia with rectal biopsy. The complete workup of the child with obstructive symptoms following a pull-through procedure includes: repeat biopsy, contrast enema and EUA.
