From
Dr. Marc Levitt
Journal of Pediatric Surgery Article Review: March 2023
With Dr. Marc Levitt · hosted by Dr. Cecilia Gigena
Chapter 1 of 5 · Fundamentals
Introduction
Introduction and Episode Overview
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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Quick Literature Updates Episode 14
4 min · Published Dec 2023
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Colorectal Surgery: What does the anesthesia provider need to know?
24 min · Published Oct 2023
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Bowel Management for Hirschsprung's Disease Patients: Pediatric Bowel...
Dr. Todd Ponsky · 34 min · Published May 2013
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Malrotation with Dr. Meera Kotagal
13 min · Published May 2023
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Laxative for Bowel Management: Pediatric Bowel Management 2013
Dr. Todd Ponsky · 26 min · Published May 2013
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Enterocolitis in Hirschsprung Disease: Update Course 2015
CCHMC Pediatric Surgery · 5 min · Published Nov 2015
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Colorectal Quiz Ep. 50 -16th Annual European Pediatric Colorectal & Pelvic Reconstruction Conference
Marc Levitt · Published Mar 2026
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Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
24 min · Published Mar 2026
Video
Colorectal Quiz Episode 33: Cloaca Exstrophy
Marc Levitt · 22 min · Published Sep 2025
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The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
Marc Levitt · 15 min · Published Sep 2025
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Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)
Marc Levitt · 40 min · Published Jul 2025
Podcast
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
Marc Levitt · 40 min · Published Jul 2025
What the experts said
The concept of gynecologic association with anorectal malformation is relatively new, launched in 2005 with the creation of the first ever clinic at Cincinnati Children's Hospital.
The sphincter reconstruction technique addresses Hirschsprung patients who had iatrogenic injury at their original pull-through, with overstretched sphincters leaving them fecally incontinent.
Of 6 patients who underwent sphincter reconstruction, 4 have done extremely well, while 2 have Down syndrome with behavioral delay in their capacity to demonstrate successful bowel function.
There is no mechanism to expect that distal to a stoma there is continuing disease or continuing problem that needs to be checked for before stoma closure.
In patients with necrotizing enterocolitis, it is reasonable to get a contrast study before stoma takedown.
VACTERL is an association defined by at least 3 anomalies in the vertebral, anorectal, cardiac, tracheoesophageal, renal, or limb systems.
In a study of 834 females with anorectal malformations, patients with ARMs and VACTERL association had more gynecologic anomalies, especially in recto vestibular and rectal perineal fistulas.
In ARM patients with VACTERL association, when one of the associated anomalies was in the renal system, there was an even higher risk of having an associated gynecological anomaly.
Besides cloaca, rectal perineal and recto vestibular fistulas in ARM patients also have an association with gynecologic anomalies.
By sphincter reconstruction, the sphincters are tightened, which allows patients to feel the stool coming and therefore improve their bowel control.
In a Dutch study of 224 patients 3 years old or younger needing stoma reversal between 1998 and 2018, 10% had strictures prior to reversal, and 95% of those with strictures had necrotizing enterocolitis.
Only one stricture case was not in a NEC patient; it was a patient treated for duodenal atresia who had a volvulus afterwards with ischemic injury of the bowel.
Of all patients in the stoma reversal study, only 68% had a contrast enema, which detected 92% of the strictures.
Most patients who develop strictures after stoma creation are those with vascular problems, particularly NEC patients.
In patients with intestinal atresia, there is a chance of having two strictures, so if an atresia is found during antegrade enema, a retrograde enema should also be performed to check for a second stricture.