Cases Presented
Video Summary of Cases Presented
The International Colorectal Web Meeting concluded 2025 with presentations from pediatric surgeons discussing four complex cases. Dr. Rafael Correia from Portugal shared a challenging case involving an 8-year-old girl with a rare presacral mass, while Dr. Andrea Bischoff presented a case of anorectal malformation in a 10-year-old boy who successfully underwent surgery to close his colostomy. Dr. Isabella Bielicki then presented a case of severe constipation in an 11-year-old boy with autism, who underwent a transanal rectosigmoid resection and Malone procedure to improve his quality of life. The meeting highlighted the complexities of managing rare pediatric colorectal conditions and the importance of collaboration between surgeons, gastroenterologists, and other specialists in providing comprehensive care for these patients.
Case 1. A Diagnostic and Surgical Dilemma: A Recto-rectal Lesion in a Female Patient 8 Years Old
Rafael Corriea, M.D.; Amadora-Sintra Hospital, Lisbon, Portugal
A complex case of an 8-year-old girl with a presacral mass, initially diagnosed as a perineal abscess. Despite initial treatment, the mass persisted, and further imaging suggested a multiloculated retrorectal cyst. The team discussed the rarity of this condition in pediatric patients and the challenges in determining the optimal surgical approach. Moderators advised on the use of a posterior sagittal approach with careful protection of the rectum and suggested obtaining a sacral X-ray to assess for any defects. The case also emphasized the importance of a thorough bowel prep and leaving a drain postoperatively to prevent fluid accumulation. The team considered the possibility of an anterior meningocele and the need for neurosurgical consultation if present.
Case 2. Male Patient Born with Anorectal Malformation
Andrea Bischoff, M.D., International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO
A complex case of a patient with anorectal malformation and sacral agenesis. The case highlighted the challenges in bowel control prognosis and surgical management. The team debated whether to repair the malformation or maintain a colostomy. The discussion emphasized the importance of advocating for individualized patient decisions based on quality of life. The presentation also disscussed the importance of thorough preoperative planning and the potential need for additional procedures, such as Malone antegrade continence enemas and bladder reconstruction.
Case 3. Male Patient 11 Years Old with Autism Spectrum Disorder and Long History of Constipation
Isabella Bielicki, M.D., International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO
This was a case of an 11-year-old boy with severe autism and constipation who underwent a transanal rectosigmoid resection after failed medical management. The surgery involved a manual disinfection, central PICC line placement, and a Malone procedure for ongoing bowel management. The patient's post-operative progress was discussed, with a discussion on the importance of the procedure in improving the patient's and family's quality of life.
Case 4. Male Patient 9 Months Old with Anorectal Malformation without Fistula
Andrea Bischoff, M.D.; International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO
A brief discussion on anal dilatations for anorectal malformations.