A 1.5 kg neonate presented with necrotizing enterocolitis with pneumoperitoneum. Intraoperatively, the situation in the peritoneal cavity was very grave, entire intestine was inflamed, edematous, friable and had cocooned to from a single lump. Very meticulously the entire small intestine was separated, distal ileum, caecum and ascending colon were found to be necrosed with multiple perforations. Right hemicolectomy with resection of the necrosed distal ileum, with end to end ileo-transverse anastomosis, with proximal diverting loop ileostomy was done. After about 2 months, ileostomy closure procedure was done uneventfully.
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