Clinical clues suggestive of low lesion 1. Bucket handle deformity - Prominent midline skin tag stem tag below which one can pass an instrument 2. Midline Raphe fistula 3. Perineal fistula - Presence of meconium coming out through a small opening anterior to anal dimple 4. Anal stenosis - Narrow anal canal 5. Anal membrane - Very thin epithelial membrane through which one can see meconium Meconuria and Flat bottom are signs suggestive of High lesion .