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 4-year-old girl who was born with an anorectal malformation (rectovestibular fistula). These malformation was repaired when she was 3 months old. As part of her VACTERL screening she was found to have: Tethered cord: released at the age of 1 year, hemisacrum and solitary left kidney with lower pole scarring. She presents with constipation and fecal incontinence. She has a history of tethered cord and a sacral ratio that is in the intermediate range. The anus is mislocated. Her potential for bowel control is likely to improve with a redo primary posterior sagittal anorectoplasty (PSARP) and correction of the anatomy. She then underwent the redo PSARP and is currently clean with one stool a day on stimulant laxatives and water-soluble fiber.
