Meconium peritonitis secondary to intestinal perforation is a feared complication of intestinal atresia, since it increases perinatal morbidity and mortality. Although it is still a rare presentation, its diagnosis must be made early to avoid complications. This case presents a clinical case of a 38-week-old newborn with no prenatal history indicative of intestinal obstruction who presents bilious / fecaloid vomiting, no meconization at 12 hours of extrauterine life, for which a standing and lying abdominal X-ray is performed showing marked distension of the intestinal loops, absence of distal air, interloop edema. An exploratory laparotomy and jejunostomy are performed to later re-intervene (second look), finding improvement in intestinal loops and achieving a jejunal-ileal end-to-end anastomosis. Early operation can be considered an important factor to improve the outcome of patients w...