Umbilicus: A Site for Stoma in Hirschsprung’s Disease

A 13-day-old male baby with the symptoms suggestive of HD and barium enema showing the transition zone (TZ) at the recto-sigmoid was admitted with progressive abdominal distention not responding to rectal washes. The baby was planned for sigmoid colostomy and seromuscular biopsy. A transverse skin incision of 2cms was made through the umbilicus under general anesthesia. The skin, subcutaneous tissue, and fascia were incised, and the umbilical vessels and urachal remnant were individually ligated apart from the opening in the fascia. At this point, a urethral sound was passed per rectally to guide the sigmoid loop towards the umbilicus. Stay sutures were taken and the loop of sigmoid colon was taken out. Biopsies were taken from the recto-sigmoid junction and site proximal to TZ. The bowel wall was fixed separately to the peritoneum and fascia with interrupted 5-0 absorbable sutures. The bowel was opened and everted with suturing to the skin (Fig. 1).