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 5-year-old female who attends the clinic for bowel management. She was born with a rectovestibular fistula that was surgically corrected at birth in another institution. She is fecally incontinent and has reduced potential for bowel control due to sacral agenesis (sacral ratio <0.4). In discussion with the parents, and given the age of the patient, a rectal enema regimen was decided on in the first instance to "get the patient clean", with the eventual aim of a laxative trial when she is older. Based on the contrast enema, the physician can estimate the volume of the enema and the additives.
