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 7-year-old boy with a history of Hirschsprung disease (HD) who underwent a transanal Soave pull-through as an infant comes to see you because he has recurrent episodes of enterocolitis. At another institution, he underwent a redo of the pull-through because of a retained transition zone, but thereafter had no improvement of symptoms. A cecostomy was then performed to treat the continued obstructive symptoms, but without improvement. Finally, in desperation, an ileostomy was opened. The ileostomy was reversed, the obstructive symptoms returned, and it was reopened. Children with HD should be able to evacuate their bowels once the aganglionic bowel has been resected.
