The Authors describe a case of meconium peritonitis in a low birth weight infant with associated malrotation of the intestines. We retrospectively analyzed the surgical approach during the stages of the disease. The purpose of this study is to stress a conservative surgical therapy (peritoneal cavity toilette and ileostomy), followed thereafter by intensive care, which should carefully balance metabolic and nutritional needs; it's then possible to perform a second look (canalization) only three mounths later, when a reasonable growth is achieved. A multidisciplinary approach favoured the positive outcome.
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