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Source created 2026-08-27 · updated 2026-08-27
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ASCRS Ch66 - Pediatric Colorectal Disorders

Chapter 66 of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Teeple EA, Azarow KS). Opens Part VI: Miscellaneous. PDF pages 1073-1087, book pages 1089-1103 (offset +16, unchanged from the Part-divider-caused jump discovered at the end of the Ch65 ingest — confirmed via the "© Springer Nature Switzerland AG 2022 1089" copyright line on the chapter's first PDF page).

Offset jump confirmed at the Ch66/Ch67 boundary: Ch66 ends on book page 1103, an odd page — per the standard chapter-boundary rule (a new chapter starts on the next odd/recto page in print, forcing a dropped blank page when the previous chapter ends on an odd page), this predicts a +1 jump to +17. Confirmed: Ch67 ("Considerations for Geriatric Patients Undergoing Colorectal Surgery") begins at PDF page 1088, book page 1105 (copyright line "© Springer Nature Switzerland AG 2022 1105") — offset +17. The sixth chapter-boundary offset jump found across the ingest arc, and a return to the standard odd-ending-page mechanism after the Part-divider-caused jump at Ch65/Ch66.

Structure and content

A broad survey chapter covering several distinct pediatric colorectal conditions, each in less depth than their adult counterparts receive elsewhere in the textbook:

  • Hirschsprung's disease (HD): three classic presentation windows; diagnosis (calretinin immunohistochemistry, the pediatric-specific caveat that anorectal manometry/RAIR is unreliable under 12 months of age); the three classic operations (Swenson, Soave with the Boley modification, Duhamel) and their equivalent success rates; a complication workup ladder; Hirschsprung-associated enterocolitis (HAEC) epidemiology and microbiome research; adult/long-term HD outcomes.
  • Colonic duplications: epidemiology, embryologic theories (split notochord, failed recanalization, abortive twinning), the Currarino triad, imaging, and excision-vs-fenestration treatment decision-making.
  • Pediatric constipation: epidemiology and natural history, HD-exclusion workup, sitz marker studies and colonic manometry, surgical options (segment resection, Botox, SNS, cecostomy), constipation-associated volvulus and perforation.
  • Pediatric rectal prolapse: natural history (90% resolve conservatively under age 4), cystic fibrosis screening, a 2018 APSA survey on first-line sclerotherapy (with specific agents/cure rates: 30% saline, 5% phenol in almond oil, 70% ethanol), Thiersch/linear cauterization/modified Thiersch, and operative options (Altemeier, Ekehorn's rectosacropexy, transcoccygeal rectopexy, laparoscopic rectopexy ± sigmoidectomy).
  • Perianal abscess and fistula-in-ano: distinct pediatric epidemiology (age/sex distribution, organism-sex association), the genuinely unsettled literature on operative vs. nonoperative management, an institutional stepwise algorithm (Fig. 66.3), and red flags (IBD/immunosuppression) for recurrent fistula beyond infancy.
  • Anal fissure: pediatric epidemiology (anterior-midline predominance in females), three GTN RCTs with mixed results, Botox-vs-myectomy comparison data, and sphincter-surgery caution in small children.
  • Cecostomy: MACE/ACE technique history and modifications, percutaneous alternatives (Chait tube), comparative trade-offs, success prediction (retrograde-enema trial, colonic manometry, bisacodyl challenge), flush regimen, and adjunctive SNS use.
  • Transitional care (ARM, HD): ARM severity spectrum and fistula-level-correlated outcomes, adult HD long-term outcome controversy, and a structured age-12-to-21 transition process.

Wiki integration

New umbrella condition page Pediatric Colorectal Disorders created, consolidating all of the above into one page (on the same organizing logic as Obstructed Defecation Syndrome (ODS) and General Postoperative Complications) rather than fragmenting into many thin pediatric-specific pages. Cross-references added throughout to the wiki's existing adult-population pages (Fecal Incontinence, Constipation, Rectal Prolapse Repair, Rectal Prolapse (Procidentia), Anorectal Abscess, Anal Fistula, Anal Fissure, Anorectal Physiology Testing, Sexual Function After Colorectal Surgery, Low Anterior Resection Syndrome (LARS)) rather than duplicating shared adult-surgery material — no other existing page was edited, since this chapter's content is pediatric-specific enough that it doesn't require reconciling against the adult-focused pages it cross-references.

Offset tracking

  • Chapter starts: PDF p.1073, book p.1089 (offset +16, confirmed via copyright line; unchanged from the Part-divider jump discovered at the end of Ch65).
  • Chapter ends: book p.1103 (odd page) → +1 jump to +17 predicted and confirmed at the Ch66/Ch67 boundary, via the standard mechanism (not a further Part divider).
  • Ch67 confirmed starting at PDF p.1088/book p.1105, offset +17 (copyright line verified).