A less than one-day Thoroughbred colt presented to Cornell’s Equine Hospital for exhibiting signs of neonatal maladjustment syndrome and inability to pass any meconium. Foaling occurred at approximately 360 days of gestation and was unattended. Shortly after birth, the foal demonstrated a poor suckle reflex, quiet mentation, difficulty rising, and wandering behavior. The foal also was not observed to pass any meconium. On the farm, the colt received a plasma transfusion due to his poor suckle reflex and multiple enemas which did produce any meconium. On presentation to Cornell, the foal was quiet, alert, and responsive. Tail flagging and straining to defecate (tenesmus) as well as attempts to suckle inappropriately, tongue protrusion and sucking, and wandering were observed. Vital parameters were within normal limits. Physical examination revealed tacky, injected oral mucous membranes, a prolonged capillary refill time of 3 seconds, and a systolic murmur which was heard loudest at the left basilar region. Point of care blood work revealed a mild metabolic alkalosis, hyperlactatemia, and hypoproteinemia. An abdominal and thoracic ultrasound was performed which revealed multiple sections of small colon distended with hypoechoic material (meconium). Several loops of small intestine also appeared thickened. Digital rectal examination confirmed hard fecal material (meconium) present at the pelvic brim. Aggressive medical therapy was instituted to allow the meconium to pass, but the colt continued to deteriorate and was eventually taken to surgery to manually milk the meconium through the small colon. The objective of this case is to present differential diagnoses for colic in foals, medical management of meconium impactions, and complications of abdominal surgery in foals.