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).

In this 2024 Update Course Rewind session, pediatric surgeons Dr. Justin Huntington and Dr. Ben Ham explore the emerging use of autofluorescence and ICG angiography during thyroid surgery. These imaging technologies are helping identify and assess parathyroid gland perfusion, with the goal of reducing hypocalcemia and improving long-term outcomes—especially in pediatric patients.

Classified as a Black Diamond (early adopter practice), this approach is still gaining traction in pediatric centers, but adult trials are already showing promise.

Key Highlights:

• What is Autofluorescence? A no-injection technique that uses natural gland fluorescence to locate parathyroids during surgery.
• ICG Angiography: Assessing real-time perfusion of glands to determine viability and reimplantation need.
• Clinical Impact: Reduced rates of post-op hypocalcemia, improved identification of glands in surgical specimens, and more targeted decision-making.
• Challenges in Practice: Equipment bulkiness, variable image quality, and limited adoption in lower-volume pediatric centers.

While further pediatric data are needed, this episode shows how new technologies may shape the future of thyroid surgery—especially in safeguarding parathyroid function.

In this 2024 Update Course Rewind, pediatric surgeons Drs. Regan Williams and Katie Russell share new updates on the management of thoracic aortic injuries. Classified as a “Black Diamond” practice—indicating unproven approaches for early adopters—this session reviews how Thoracic Endovascular Aortic Repair (TEVAR) is emerging as a less invasive and effective treatment option in pediatric patients, especially adolescents.

Host: Lizzy Lee, PA-C

Key Takeaways:

• Prioritize stabilization and life-threatening injuries before addressing thoracic aortic injury.
• Thoracic aortic injuries in children are rare and can be easily missed—maintain a high index of suspicion.
• A widened mediastinum on chest X-ray should prompt a CT chest to evaluate for vascular injury.
• Decisions should be guided by patient age, injury severity, and available expertise at your institution.
• Collaboration with vascular surgeons or interventional radiologists is essential for optimal care.