# Total Colonic Hirschsprung — GCMD Library living collection

Everything in the library about total colonic Hirschsprung — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 55 cited statements

## Episodes
### Evidence & Research
- [Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653) — podcast · 24:17 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653.md)
- [Colorectal Quiz Episode 50: Key Takeaways from the 16th European Pediatric Colorectal Conference](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859) — podcast · 24:17 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859.md)

### Case-Based Learning
- [Total Colonic Hirschsprung Disease with Malrotation: Difficult Cases](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052) — video · 13:15 · [machine version](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052.md)

## Chapters
- [0:02](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=2) Case Presentation: Total Colonic Hirschsprung with Malrotation (Ep 1)
- [3:03](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=183) Clinical Questions and Literature Review (Ep 1)
- [5:09](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=309) Faculty Discussion: Malrotation with Hirschsprung and Procedure Selection (Ep 1)
- [8:19](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=499) Nutritional Management and Procedure Choice Debate (Ep 1)
- [12:22](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=742) Final Comments on Continence and Technique (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=0) Introduction and Hirschsprung Irrigation Competency (Ep 2)
- [3:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=187) Skincare Management in Total Colonic Hirschsprung Patients (Ep 2)
- [4:43](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=283) Diet, Minimally Invasive Techniques, and Robotic Surgery (Ep 2)
- [7:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=460) Goblet Cells, Bowel Stress, and Pull-Through Decompensation (Ep 2)
- [10:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=627) Dedicated Nursing Programs and Allied Health Component (Ep 2)
- [13:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=819) Transition of Care and Multidisciplinary Adult Services (Ep 2)
- [16:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=962) Anorectal Malformation Techniques and Cloaca Management (Ep 2)
- [20:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1245) General Pediatric Proctology: Anal Fissure and Crohn Disease (Ep 2)
- [22:13](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1333) Conference Attendance and Closing Remarks (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=0) Introduction and Hirschsprung irrigation strategies (Ep 3)
- [3:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=187) Skincare management and dietary considerations (Ep 3)
- [5:16](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=316) Minimally invasive techniques and scientific insights (Ep 3)
- [8:30](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=510) Pull-through decompensation and proactive management (Ep 3)
- [10:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=627) Nursing programs and transition of care (Ep 3)
- [15:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=955) Anorectal malformation techniques and cloaca management (Ep 3)
- [20:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1245) General pediatric proctology (Ep 3)
- [22:13](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1333) Conference attendance and closing remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The infant presented with delayed passage of meconium of more than 48 hours, but passed meconium after examination. — Jafar (clinical) [Ep 1 · 0:18](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=18)
- At day 7 of age, the infant presented with signs and symptoms of Hirschsprung disease including abdominal distension, tight rectum with passage of explosive stool after removing the examining finger. — Jafar (clinical) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=30)
- Full thickness rectal biopsy confirmed the absence of ganglion cells. — Jafar (clinical) [Ep 1 · 0:44](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=44)
- On laparotomy for colostomy creation, malrotation with multiple bands was found: one band between loops of bowel, one between bowel and liver, and one between bowel and abdominal wall. — Jafar (clinical) [Ep 1 · 0:52](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=52)
- Biopsy from the appendix and terminal ileum proved total colonic aganglionosis. — Jafar (clinical) [Ep 1 · 1:32](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=92)
- Postoperatively, the infant received IV fluids, antibiotics, and total parenteral nutrition, then was started on high-calorie formula (Ensure) with vitamin B12 supplementation after bowel function returned. — Jafar (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=99)
- The infant developed multiple attacks of dehydration requiring hospital admission for IV fluid replacement. — Jafar (clinical) [Ep 1 · 2:04](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=124)
- Only a few cases have been reported of total colonic Hirschsprung associated with malrotation: Philone reported 4 patients, one author reported 1 patient, and Zbra reported 3 patients, but no cases reported all three anomalies (total colonic Hirschsprung, malrotation, and congenital bands). — Jafar (epidemiological) [Ep 1 · 3:16](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=196)
- Congenital bands in this context are rare; the etiology is unknown but could be attributed to antenatal perforation of the bowel. — Jafar (clinical) [Ep 1 · 3:46](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=226)
- The usual scenario for malrotation with Hirschsprung is a child with bilious vomiting who gets a contrast study showing malrotation, undergoes Ladd procedure, but then doesn't open up, prompting reconsideration of other causes. (clinical) [Ep 1 · 5:20](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=320)
- Once a Ladd procedure is done, if the baby doesn't open up, you must think about other potential causes for bilious vomiting. (clinical) [Ep 1 · 5:42](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=342)
- Hirschsprung associated with malrotation is usually short segment, not total colonic, but follows the same distribution as Hirschsprung in general. (epidemiological) [Ep 1 · 5:54](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=354)
- For total colonic Hirschsprung, the preferred operation is Duhamel because it is simple, safe, and provides a reservoir at the bottom, which Soave does not. (opinion) [Ep 1 · 6:19](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=379)
- Timing of definitive repair should be based on consistency of ileostomy output, not age or weight; patients don't do well if operated too early when output is still liquidy. (opinion) [Ep 1 · 6:41](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=401)
- It is preferable to wait until ileostomy output firms up, which usually happens when the infant gets onto solid food. (opinion) [Ep 1 · 6:55](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=415)
- For long segment or total colonic Hirschsprung, a relatively short piece of colon should be left, creating a small reservoir rather than the longer Martin modification element. (opinion) [Ep 1 · 7:07](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=427)
- Good control in long segment Hirschsprung disease is really about 50% of patients; the data really isn't that great. (epidemiological) [Ep 1 · 7:32](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=452)
- When long segment Hirschsprung involves more than 50 cm from the ileocecal valve, it is a much more progressive disease with a bigger dysmotility element. (clinical) [Ep 1 · 7:51](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=471)
- There is no evidence in the literature that any particular procedure should be done just because the patient has long segment Hirschsprung; the best approach is to use whatever procedure the surgeon has had the best results with. — Sharif (opinion) [Ep 1 · 8:31](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=511)
- Poor weight gain in an infant with ileostomy receiving adequate calories and normal blood tests often has to do with sodium loss. — Sharif (clinical) [Ep 1 · 9:18](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=558)
- Unless sodium levels in the effluent are checked, sodium loss will not be caught because serum sodium will be normal for many months before it starts to decrease. — Sharif (clinical) [Ep 1 · 9:49](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=589)
- If ileostomy output contains more than 5 to 7 mEq per liter of sodium, the baby will not grow or gain weight. — Sharif (clinical) [Ep 1 · 9:57](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=597)
- The baby must be gaining weight and growing before proceeding with definitive repair. — Sharif (opinion) [Ep 1 · 10:04](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=604)
- Measuring urinary sodium is the best way to guide how much sodium replacement to give. (opinion) [Ep 1 · 10:10](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=610)
- Every baby with an ileostomy should probably get sodium supplementation. (opinion) [Ep 1 · 10:10](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=610)
- Iron deficiency is a big long-term issue with any repairs in these patients and is often forgotten. (clinical) [Ep 1 · 10:26](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=626)
- For total colonic Hirschsprung, if doing Soave or other procedure, you must wait until the baby grows and the ileostomy is thicker, then can continue with bulking agents or antidiarrheal agents. (opinion) [Ep 1 · 10:46](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=646)
- Some patients who had Duhamel done abroad came back with problems including enterocolitis, obstruction, and distension of the Duhamel pouch. (clinical) [Ep 1 · 11:20](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=680)
- The baby should be monitored for ileostomy output before deciding on any procedure; some patients with ileoanal anastomosis developed severe perianal erosion requiring protective ileostomy before further procedures. (clinical) [Ep 1 · 11:42](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=702)
- Soave for regular Hirschsprung disease patients (not total colonic) does not result in incontinence if the procedure is followed well and sphincters are not damaged. (opinion) [Ep 1 · 12:40](https://library.globalcastmd.com/watch/total-colonic-hirschsprung-disease-with-malrotation-difficult-cases-1052?t=760)
- Many centers are starting irrigation competency even with an ostomy in place, particularly for total colonic Hirschsprung patients, to ease the transition after takedown. — Lindsey Clarke (clinical) [Ep 2 · 1:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=77)
- Total colonic Hirschsprung patients with a stoma are the highest risk group for enterocolitis and must receive irrigation teaching before pull-through. — Marc Levitt (clinical) [Ep 2 · 2:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=165)
- Diet management for Hirschsprung patients is not one size fits all; families must identify individual food triggers through pattern recognition. — Lindsey Clarke (clinical) [Ep 2 · 4:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=288)
- Most Hirschsprung pull-throughs that decompensate had good original pathology but were not aggressively managed post-operatively with laxatives and Botox when needed. — Marc Levitt (clinical) [Ep 2 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=579)
- The 16th European Pediatric Colorectal meeting had the largest nursing attendance of any of the previous 15 meetings. — Marc Levitt (epidemiological) [Ep 2 · 10:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=635)
- Without nursing partners, surgeons cannot achieve good functional outcomes; two patients with identical technical repairs can have totally different results based on nursing care quality. — Marc Levitt (opinion) [Ep 2 · 11:41](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=701)
- Adult colorectal surgeons need to understand what Hirschsprung disease and anorectal malformation patients might need when they are 50 years old with complications like rectal prolapse. — Marc Levitt (opinion) [Ep 2 · 15:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=929)
- In vestibular fistula repair, dissection does not need to reach the areolar plane between anterior rectum and posterior vagina; the key is ensuring the rectum has no tension during anoplasty. — Marc Levitt (clinical) [Ep 2 · 17:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1038)
- Mullerian structures that look atretic may actually grow into real useful structures, supporting a strategy of waiting rather than immediate reconstruction. — Marc Levitt (clinical) [Ep 2 · 19:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1164)
- A bowel neovagina can bridge the gap when native vagina does not reach after urogenital separation, and can be removed in the future when the native vagina is pulled through after puberty. — Marc Levitt (clinical) [Ep 2 · 19:50](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1190)
- The 16th European Pediatric Colorectal meeting had well over 250 attendees from diverse international locations including Asia, Bangladesh, Thailand, Vietnam, and multiple U.S. states. — Marc Levitt (epidemiological) [Ep 2 · 22:20](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1340)
- Many centers are starting irrigation competency training even with an ostomy in place, particularly for total colonic Hirschsprung patients who may have delayed takedown. — Lindsey Clarke (clinical) [Ep 3 · 1:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=77)
- Starting irrigations 1-2 times per week early on in patients with stomas helps children and parents adapt, making the transition after takedown much easier. — Lindsey Clarke (clinical) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=113)
- Patients with total colonic Hirschsprung and stomas represent the highest risk group for enterocolitis and must receive irrigation training before pull-through. — Marc Levitt (clinical) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=165)
- Diet management for Hirschsprung patients is not one size fits all; families must identify individual food triggers through pattern recognition. — Lindsey Clarke (clinical) [Ep 3 · 4:48](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=288)
- ICG (indocyanine green fluorescence imaging) is used to check blood supply of pull-throughs and can reduce the risk of leaks and ischemia. — Felipe Jali (clinical) [Ep 3 · 5:32](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=332)
- Most pull-throughs that decompensate had good original pathology but were not aggressively managed post-operatively with laxatives and Botox when needed. — Marc Levitt (clinical) [Ep 3 · 9:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=579)
- Proactive monitoring for obstructive behavior and early intervention with laxatives and Botox prevents pull-through decompensation. — Marc Levitt (clinical) [Ep 3 · 10:03](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=603)
- Without good nursing care, patients with anatomically elegant reconstructions may have poor functional outcomes. — Marc Levitt (opinion) [Ep 3 · 11:45](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=705)
- More than an adult surgeon, transition patients often need a sexologist, gynecologist, or urologist rather than a colorectal surgeon. — Felipe Jali (opinion) [Ep 3 · 14:08](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=848)
- Adult colorectal surgeons need training to understand what Hirschsprung disease and anorectal malformation patients might need when they are 50 years old with complications like rectal prolapse. — Marc Levitt (opinion) [Ep 3 · 15:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=925)
- In vestibular fistula repair, dissection does not need to reach the areolar plane between anterior rectum and posterior vagina; the key is ensuring no tension on the rectum during anoplasty. — Marc Levitt (clinical) [Ep 3 · 17:31](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1051)
- Cloaca patients need long-term follow-up through puberty to avoid menstrual obstruction, incapacity for egress, and consequent risk of endometriosis and damage to uterus and fallopian tubes. — Felipe Jali (clinical) [Ep 3 · 18:44](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1124)
- Mullerian structures that appear atretic may grow into useful structures over time. — Marc Levitt (clinical) [Ep 3 · 19:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1164)
- In most cloaca cases after urogenital separation, the native vagina will reach the perineum; if it does not, a bowel neovagina can bridge the gap and be removed later when the native vagina is pulled through after puberty. — Marc Levitt (clinical) [Ep 3 · 19:42](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1182)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Enterocolitis remains a risk for Hirschsprung patients even after pull-through, at about a rate of 20% of all patients. — The host summarizing the discussion [Ep 2 · 2:13](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=133)
- Regular irrigations minimize enterocolitis risk in Hirschsprung patients. — The host summarizing the discussion [Ep 2 · 2:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=141)
- Most centers still do some kind of stool crusting—putting stool on the patient's bottom while they have a stoma for small periods of time—to help get their bottom used to it. — Meghan Mesa summarizing the discussion [Ep 2 · 3:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=215)
- Betel leaf was used in Bangladesh as a barrier for peristomal skin with excellent results, showing pristine skin underneath. — Marc Levitt summarizing the discussion [Ep 2 · 3:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=239)
- There have been advances in robotic-assisted Hirschsprung repair and the use of ICG (indocyanine green fluorescence imaging) to check blood supply of pull-throughs. — Felipe Gli summarizing the discussion [Ep 2 · 5:23](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=323)
- ICG fluorescence imaging is used to assess real-time tissue perfusion and vascularity during pull-throughs and can reduce the risk of leaks and ischemia. — The host summarizing the discussion [Ep 2 · 5:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=336)
- High-frequency ultrasound measurement of internal muscle thickness can help determine the segment of aganglionic bowel in Hirschsprung disease, potentially avoiding biopsy. — Felipe Gli summarizing the discussion [Ep 2 · 5:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=349)
- Robotic colorectal surgery is becoming feasible in children less than 10 kg because equipment is improving. — Marc Levitt summarizing the discussion [Ep 2 · 6:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=400)
- Robotic surgery is not as expensive anymore as it used to be; expenses are almost equivalent to other techniques. — Felipe Gli summarizing the discussion [Ep 2 · 6:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=411)
- Single-incision laparoscopic Malone procedures were presented with really great results and better post-operative recovery. — Felipe Gli summarizing the discussion [Ep 2 · 7:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=441)
- Goblet cells increase from proximal to distal colon, and the mucosal mucus layer has a protective role; more proximal resection may increase enterocolitis risk because proximal segments produce less mucus. — Marc Levitt summarizing the discussion [Ep 2 · 7:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=460)
- Mechanical stress and distension on the bowel wall leads to increased gut microbial dysbiosis and breakdown of the mucosal lining and barrier, with upregulation of pro-inflammatory factors affecting immune response. — Marc Levitt summarizing the discussion [Ep 2 · 8:37](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=517)
- Transition programs for pediatric colorectal patients often fail or are lacking in many parts of the world; patients need sexologists, gynecologists, and urologists more than adult colorectal surgeons. — Felipe Gli summarizing the discussion [Ep 2 · 13:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=829)
- The Ready Steady Go program uses patient questionnaires to assess knowledge of disease, symptoms, and readiness for transition to adult care. — The host summarizing the discussion [Ep 2 · 14:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=880)
- The perineal-preserving PSARP (PPP) avoids perineal body dissection and the risk of dehiscence, potentially eliminating the need for colostomies in some patients. — Marc Levitt summarizing the discussion [Ep 2 · 16:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=985)
- The posterectal advancement anoplasty (PRAA) mobilizes only the posterior rectal wall in males with perineal fistula and some females when the fistula is in the anteriormost extent of the sphincteric ellipse. — Marc Levitt summarizing the discussion [Ep 2 · 16:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1017)
- Delaying vaginal reconstruction in cloaca may allow for other surgical options with less morbidity and avoid bowel vaginoplasty. — Felipe Gli summarizing the discussion [Ep 2 · 18:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1087)
- A bowel neovagina can hold the spot in cloaca patients and be resected later in life when the patient is older. — Felipe Gli summarizing the discussion [Ep 2 · 18:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1107)
- Cloaca patients need long-term follow-up during puberty to avoid menstrual obstruction, incapacity for egress, and risk of endometriosis and damage to uterus and fallopian tubes. — Felipe Gli summarizing the discussion [Ep 2 · 18:44](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1124)
- Removal of the skin tag in chronic anal fissure can lead to better long-term healing, along with injection of 20 to 50 units of Botox. — Felipe Gli summarizing the discussion [Ep 2 · 21:04](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1264)
- There is a higher incidence of perianal disease in children with Crohn disease, and perianal disease can be the first hint that a patient will develop Crohn disease. — Marc Levitt summarizing the discussion [Ep 2 · 21:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1295)
- Enteral nutrition is as effective as steroids in treating transmural inflammation or stenosis of the small bowel in Crohn disease. — Marc Levitt summarizing the discussion [Ep 2 · 21:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-16th-annual-european-pediatric-colorectal-and-pelvic-11653?t=1313)
- Enterocolitis remains a risk for Hirschsprung patients even after pull-through, at about a rate of 20% of all patients. — The host summarizing the discussion [Ep 3 · 2:13](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=133)
- Regular irrigations minimize enterocolitis risk. — The host summarizing the discussion [Ep 3 · 2:21](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=141)
- Most centers still do some kind of crusting, putting stool on the baby's bottom while they have a stoma for small periods of time to help get their bottom used to it. — Meghan Mesa summarizing the discussion [Ep 3 · 3:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=215)
- Betel leaf used for peristomal skin in Bangladesh produced pristine skin as an effective barrier. — Marc Levitt summarizing the discussion [Ep 3 · 3:59](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=239)
- High frequency ultrasound measurement of internal muscle thickness can help determine the segment of aganglionic bowel and may be used together with biopsies. — Felipe Jali summarizing the discussion [Ep 3 · 5:49](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=349)
- Improved instrumentation is making robotic colorectal surgery feasible in children less than 10 kg. — Marc Levitt summarizing the discussion [Ep 3 · 6:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=400)
- Robotic surgery expenses have become almost equivalent to other techniques. — Felipe Jali summarizing the discussion [Ep 3 · 6:51](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=411)
- Goblet cells increase from proximal to distal colon, producing more mucus distally, which may explain why more extensive resection increases enterocolitis risk due to less mucosal protection. — Marc Levitt summarizing the discussion [Ep 3 · 7:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=460)
- Mechanical stress and distension on the bowel wall leads to increased gut microbial dysbiosis and breakdown of the mucosal barrier, with upregulation of pro-inflammatory factors affecting immune response. — Marc Levitt summarizing the discussion [Ep 3 · 8:37](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=517)
- The Ready, Steady Go program uses patient questionnaires to assess knowledge of disease, symptoms, and readiness for transition. — The host summarizing the discussion [Ep 3 · 14:40](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=880)
- The PPP (perineal preserving PSARP) avoids perineal body dissection and the risk of dehiscence, potentially eliminating the need for colostomies in many patients. — Marc Levitt summarizing the discussion [Ep 3 · 16:25](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=985)
- The PRAA (posterectal advancement anoplasty) mobilizes only the posterior rectal wall in males with perineal fistula and some females when the fistula is in the anteriormost extent of the sphincteric ellipse. — Marc Levitt summarizing the discussion [Ep 3 · 16:57](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1017)
- Delaying vaginal reconstruction in cloaca may allow for other surgical options with less morbidity and potentially avoid bowel vaginoplasty. — Felipe Jali summarizing the discussion [Ep 3 · 18:07](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1087)
- A bowel neovagina can hold the spot in cloaca patients and may be resected later in life when the patient is older. — Felipe Jali summarizing the discussion [Ep 3 · 18:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1107)
- Removal of the skin tag in chronic anal fissure, along with injection of 20-50 units of Botox, can lead to better long-term healing. — Felipe Jali summarizing the discussion [Ep 3 · 21:02](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1262)
- There is a higher incidence of perianal disease in children with Crohn's disease, and this can be the first hint that the patient will develop Crohn's disease. — Marc Levitt summarizing the discussion [Ep 3 · 21:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1295)
- Enteral nutrition is as effective as steroids in treating transmural inflammation or stenosis of the small bowel in Crohn's disease. — Marc Levitt summarizing the discussion [Ep 3 · 21:53](https://library.globalcastmd.com/watch/colorectal-quiz-episode-50-key-takeaways-from-the-16th-european-pediatric-colore-16859?t=1313)

## Changelog
- Nov 11: 3 items added automatically

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