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Small intestinal atresia (SIA) in neonates is a relatively rare event with a reported prevalence of 1.6 per 10 000 births. 1 There are few clinical cases in literature that demonstrate relationship between intrauterine intussusceptions and ileal atresia. We report a similar case of a newborn who presented with intestinal atresia on day 1 of life.2 3Intrauterine intussusception (also called antenatal intussusception) is a rare cause of congenital intestinal atresia, particularly ileal atresia. The proposed mechanisms include abnormal fetal peristalsis or vascular compromise leading to intussusception, which causes ischemia, necrosis, and resorption, ultimately resulting in atresia. The incidence of this latter cause of intestinal atresia has been described between 0.6% and 13%4 or 25% of all ileal atresia.5We describe the case of a female newborn who was born at 38+2 weeks of gestation by EMCS due to reduced foetal movements at a DGH. Baby was born poorly and needed resuscitation at birth with intubation and ventilation. Clinical examination at that time showed increasing abdominal distension and bilious vomiting. This led the team to perform an X-ray abdomen which showed dilated bowel loops pushed to the left side, free air in the abdomen(Falciform ligament sign) and no gas in the rectum. Baby was urgently transferred to a tertiary centre for surgical input. On Day 2 of life baby had a laparotomy with right hemicolectomy and ileostomy.A diagnosis of type 2 ileal atresia was confirmed along with other findings of matted loops of terminal ileum, multiple (four) perforations and gross contamination of the peritoneal cavity. Following the intervention, baby started recovering and was extubated the day after. The bilious aspirates also started clearing up and reducing in amount. Baby was given support with PN and antibiotics and continued to improve.The early presentation and the operative findings of type 2 ileal atresia with matted terminal ileal loops, multiple perforations, and gross peritoneal contamination strongly suggests a prenatal ischemic insult as the initiating event leading to the vascular compromise and resultant atresia. Among the recognized mechanisms, intrauterine intussusception is a well-documented cause of jejunoileal atresia, resulting from compromised mesenteric blood flow to the intussuscepted segment. This leads to ischemic necrosis, resorption of the affected bowel, and formation of blind ends connected by a fibrous cord, as seen in type 2 atresia. The presence of adhesions and perforations in this case likely reflects postnatal progression of injury in an already compromised segment. Recognition of intrauterine vascular events such as intussusception as potential causes of ileal atresia highlights the complex prenatal origin of neonatal intestinal obstruction and reinforces the importance of early diagnosis and prompt surgical intervention to prevent further bowel loss. Awareness of such intrauterine events is important, as early recognition and prompt surgical management are key to minimising bowel loss and improving neonatal outcomes. Also, cystic fibrosis remains an important co-morbid condition that must be excluded promptly in all newborns with intestinal atresia. Fast diagnosis and effective interdisciplinary team work are essential for a satisfying outcome.References Bianchi F, et al. Epidemiology of small intestinal atresia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed. 2012;97:F183-8.Joshi SB, Kinhal V, Desai M, Tilak, Choudhari FU. A rare case of jejunal atresia due to intrauterine intussusception. J Clin Diagn Res. 2015 Sep;9(9):PD30-1. doi: 10.7860/JCDR/2015/14063.6566. Epub 2015 Sep 1. PMID: 26500958; PMCID: PMC4606287.Sarin YK. Intrauterine intussusception causing ileal atresia. APSP J Case Rep. 2010 Jul;1(2):18. Epub 2010 Dec 1. PMID: 22953261; PMCID: PMC3417996.de Luca U, Esposito C, Porreca A. Intrauterine intussusception as a cause of ileal atresia occurring late during pregnancy. Eur J Pediatr Surg. 1995 Apr;5(2):116–8. doi: 10.1055/s-2008-1066182. PMID: 7612581.Komuro H, Hori T, Amagai T, Hirai M, Yotsumoto K, Urita Y, Gotoh C, Kaneko M. The etiologic role of intrauterine volvulus and intussusception in jejunoileal atresia. J Pediatr Surg. 2004 Dec;39(12):1812–4. doi: 10.1016/j.jpedsurg.2004.08.037. PMID: 15616938.