Neonatal intestinal obstruction presents with the triad of: bilious vomiting, abdominal distension, and delay or failure to pass meconium. Initial resuscitation followed by a systematic approach to investigation, thorough clinical examination and radiological investigations, is imperative. Plain abdominal x-ray serves to differentiate between proximal and distal obstruction in the majority of cases and directs whether further upper or lower GI contrast studies are needed. Malrotation with volvulus and bowel perforation evidently need emergency intervention, but consideration of the septic neonate also presenting acutely unwell is necessary, as well as cases of functional obstruction such as Hirschsprung disease. Short gut secondary to loss of bowel is associated with major morbidity, and steps to mitigate this adverse outcome are imperative.