Background: Scrotal swelling in the neonatal period is a common finding with a range of underlying causative processes, ranging from the benign to surgical emergencies. This case highlights some of the diagnostic difficulties in an unusual clinical presentation. Case Presentation: We describe a case of antenatal intestinal perforation presenting as scrotal swelling in a newborn of 35 weeks gestation. Antenatal ultrasound scans had not raised suspicion and there was no abdominal distension apparent in the immediate neonatal period. Clinical impression was initially of testicular torsion prior to radiological assessment, which demonstrated pneumoscrotum and free peritoneal gas requiring urgent surgery. Conclusion: It is important to consider intra-abdominal pathology in association with a patent processus vaginalis as a cause for scrotal swelling in the newborn, in addition to urological causes. Following surgical management, it is important to exclude cystic fibrosis as an underlying cause for meconium ileus.

Keywords: Intestinal perforation; scrotal swelling; neonate; case report