The diagnosis is suspected based on polyhydramnios in uteru, bilious vomiting, failure to pass meconium in the first day of life, and abdominal distension.[3] The presentations of NBO may vary.[4] It may be subtle and easily overlooked on physical examination or can involve massive abdominal distension, respiratory distress and cardiovascular collapse.[4] Unlike older children, neonates with unrecognized intestinal obstruction deteriorate rapidly.[5]