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 12-year-old boy who has known Hirschsprung disease and underwent a Duhamel pull-through as a newborn with the transition zone being in the rectosigmoid. He developed multiple episodes of enterocolitis postoperatively, and this eventually resulted in him being managed with a defunctioning ileostomy at the age of 1 year. The original surgeons felt that the patient would benefit from a myotomy to relieve the obstructive symptoms and this was performed at 4 years of age. The ileostomy was reversed following the myotomy. The Duhamel pouch was thought to be problematic, with failure to empty, and this was resected at 12 years of age and converted to a Swenson pull-through (coloanal anastomosis).