In this episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and special guest Dr. Julia Grabowski from Lurie Children’s dive deep into the diagnosis and management of anal stenosis in infants. They walk through the case of a 10-month-old presenting with constipation and distention, leading to a discussion on clinical exams, imaging, biopsy pitfalls, and surgical strategies.

Key Highlights:

• Physical Exam Essentials: Why a thorough digital rectal exam is critical and when to use a Hegar dilator vs. relying on feel.
• Distinguishing Anal Stenosis vs. Hirschsprung Disease: How misdiagnoses occur and why biopsies can be misleading if not done correctly.
• Surgical Management: Principles of preserving the anterior anal canal to protect continence during posterior sagittal approaches.
• Megarectosigmoid Management: Why most dilated rectums improve after addressing the obstruction and when a Malone procedure can prevent the need for resection.
• Special Considerations: The importance of spinal and pelvic MRI to rule out associated presacral masses before surgery.

This episode underscores the importance of a meticulous clinical approach, interdisciplinary review, and cautious surgical planning in treating children with suspected anal stenosis.