In this episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and special guests Dr. Chris Gayer and Dr. Sarah Ulrich tackle the complexities of managing megarectosigmoid in a 13-year-old patient with a history of cloaca. They explore the intricacies of diagnosis, anatomy, and long-term management for a child struggling with soiling despite a well-positioned rectum and no anatomical stricture.

Key Highlights:

• Case Discussion: A deep dive into a patient with severe rectal dilation despite a perineal repair and normal bladder function.
• Diagnostic Strategy: The role of MRI, EUA, contrast enema, and sacral assessment to understand anatomy and guide treatment.
• Treatment Options: From Malone procedures to tapering and resection—what’s the right next step?
• Surgical Pearls: When to preserve the rectum and when to consider redoing the entire repair.

This episode is packed with expert commentary, clinical pearls, and plenty of humor (including a colorectal-themed joke from a young patient).