Intrauterine Sigmoid Colon Perforation Presenting as Prenatal Meconium Peritonitis: A Case Report

Introduction: Meconium peritonitis is a rare fetal condition caused by intrauterine bowel perforation.Small bowel perforation is the typical underlying pathology; colonic perforation, particularly sigmoid involvement, is extremely uncommon.Case description: A 34-week gravid patient underwent routine ultrasound, which showed fetal ascites with loss of large bowel architecture suggestive of fetal meconium peritonitis.Due to subsequent pathological fetal heart rate decelerations, an emergency cesarean section was performed.The neonate presented with a markedly distended abdomen at birth.Exploratory laparotomy demonstrated a distal sigmoid colon perforation with no obstructive pathology.Resection with Hartmann's procedure and diversion stomas was performed.The infant later developed sepsis and succumbed to it following transfer.Conclusion: This case highlights sigmoid perforation as a rare etiology of meconium peritonitis.Early antenatal suspicion, rapid escalation, and multidisciplinary approach remain critical, although mortality in complex meconium peritonitis can still occur despite timely intervention.