ABSTRACT
Introduction: The paper discusses the challenges in providing care for children from underserved rural areas, for complex surgical conditions. It highlights the need to empower selected secondary hospitals to handle paediatric cases that represent a significant burden of surgical admissions, such as Pediatric Colorectal Diseases (PCRD), and risk inappropriate treatment when seen at a peripheral health facility level, as financial or transportation difficulties constrain access to a specialist hub. Materials and Methods: The study examines the capacity acquired by a secondary health facility to provide surgical care for Anorectal Malformations (ARM) and Hirschsprung's Diseases (HSCR) in terms of diagnostic accuracy, appropriate management, reduced complications, and favourable outcomes. The hospital serves a large catchment area with approximately 10 million people, including 45% who are under the age of 15. Results: Among 966 paediatric surgical admissions during the study period, ninety-four were referred for colorectal disease (ARM and HSCR). The document details the types of surgeries performed, complications encountered, and outcomes achieved. Posterior Sagittal Anorectoplasty (PSARP) was performed in 28 out of 42 ARM cases observed (66%) at a mean age of three years, and four were scheduled for treatment in a short time. Forty-six out of 48 HSCR cases could be treated with a favourable outcome by abdominoperineal pull-through or posterior rectal sphincterotomy. Conclusion: Extending specialist surgical coverage for children through selected secondary facilities with upgraded local capacities can significantly improve the management of Pediatric Colorectal Diseases in underserved areas, making appropriate staged treatments and close postoperative follow-up more accessible.

ABSTRACT
Congenital arteriovenous fistula is an extremely rare vascular malformation. Its symptomatology is variable and depends on its size as well as its location. We report the case of a 12-year-old girl with no known medical or surgical history, who was referred for an ultrasound examination at the Abidjan Heart Institute. Doppler ultrasound of the upper limb revealed a high-flow brachio-brachial arteriovenous fistula. The patient was subsequently transferred to the vascular surgery department for management.