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Regarding management of anal stenosis

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quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji -

1. For all anal stenosis (and rectal atresia) cases you must check for a presacral mass.

2. For any such presacral mass, always make sure there is no dural component (pelvic plus spinal MRI) and, if present, involve neurosurgery.

3. If Currarino syndrome, genetic testing is warranted for the patient and first-degree relatives.

4. For management, removal of the mass is key which will likely solve much of the constipation.

5. If the anus is narrow that must be treated; an anal canal sparing technique can accomplish this. Occasionally, dilation alone can work.

6. With mass removal the colon should improve, although in such a case antegrade flush access with a Malone may be beneficial to promote daily colonic emptying.

7. Whether the colon will recover is a key question, but it can be decided later whether a colon resection is required.

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