Abstract
Meconium peritonitis (MP) as a cause of non-immune hydrops in neonates is rarely reported. We present a case of a 35-week gestational-age male neonate diagnosed with hydrops secondary to MP. Antenatal scan at 34 weeks and five days revealed features of fetal hydrops, and the prenatal workup did not reveal the etiology. Postnatal imaging confirmed MP with abdominal calcifications, and the neonate developed pneumoperitoneum due to intestinal perforation. Emergency laparotomy revealed diffuse MP without a definitive site of perforation. An ileostomy was created and closed before discharge. Follow-up showed normal growth and development, emphasizing the importance of early diagnosis and multidisciplinary management in such rare cases. MP, though rare, should be considered in the differential diagnosis of non-immune hydrops fetalis (NIHF), particularly in the presence of fetal ascites.