Barthel et al. Journal of Medical Case Reports 2012, 6:229 http://www.jmedicalcasereports.com/content/6/1/229 drainage procedure, and definitive stoma creation was delayed for one month. A similar strategy has been reported previously [15]. These authors presented two cases in which they placed external drains under ultra- sound guidance, and then waited 16 and 20 days, re- spectively, before proceeding to laparotomy. They elected to perform a primary ileal anastomosis at surgery in both patients. However, we chose to bring out a stoma at delayed laparotomy given their patient’s pro- longed neonatal intensive care unity stay and sepsis course. While our choice of stoma creation, rather than primary anastomosis, is consistent with the recommen- dations of Copeland et al. [9] given the birth weight of 2.2 kg, we stress that our decision to start with a tem- porary drainage procedure prior to definitive surgery is more consistent with the initial management by Ellis et al. [11]. Conclusion A classic appearance of large calcifications on plain ab- dominal films in the setting of a distended and distressed neonate should place giant cystic meconium peritonitis high upon the differential diagnosis. Initial peritoneal drainage with a delay in definitive surgical management is a reasonable approach in the setting of massive meco- nium soiling of the abdominal cavity that prohibits the safe identification of bowel loops for stoma creation. At reoperation, bringing out a stoma is a safe option, espe- cially for low birth weight infants. Consent Written informed consent was obtained from the patient’s next-of-kin for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors’ contributions ERB, ALS and DEL performed the literature search and wrote the manuscript. BJN-M and TG performed the surgeries, provided intraoperative images and critically reviewed the manuscript prior to submission. All authors have read and approved the final manuscript. Acknowledgements The authors thank the reviewers for many thoughtful suggestions for revising our original manuscript. We also are grateful to the Children’s Hospital Los Angeles Division of Pediatric Surgery for educational and logistical support. ERB and TCG are supported by the California Institute for Regenerative Medicine, grant numbers TG2-01168 and RN2-00946-1, respectively. ALS is supported by a Society of University Surgeons Ethicon Scholarship. Author details 1Children’s Hospital Los Angeles Division of Pediatric Surgery, 4650 Sunset Boulevard Mailstop 35, Los Angeles, CA 90027, USA. 2Pediatric Surgery, Texas Children’s Clinical Care Center, 6701 Fannin Street, 8th Floor, Houston, TX 77030, USA. 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