A 33-week infant was born to a gravida eight mother with a poor obstetric history. A late second trimester scan had shown a large intra-abdominal cyst in the fetus and polyhydramnios. The mother went into spontaneous labour at 33 weeks and a male baby was delivered by caesarean section. Soon after birth the infant was noted to have abdominal distension and bilious aspirates. A radiograph of the abdomen revealed a calcified mass suggestive of meconium pseudocyst (fig 1). Laparotomy on the second postnatal day revealed a meconium pseudocyst located between the liver, stomach and transverse colon with many adhesions. There were two perforations from the terminal ileum into the pseudocyst approximately 10 cm from the ileo-caecal valve. The cyst was excised and a split ileostomy was performed. The ileostomy was reversed and an end to end anastamosis performed a month later. The baby recovered well post-operatively and on follow-up was thriving well.