Transmesenteric hernia (TMH) is a rare cause of small bowel obstruction. If left untreated, mortality rates are high. In this case report, the authors describe a case of TMH in a preterm neonate born at gestational age 36 + 1 with abdominal distention, subumbilical discolouration and difficulty breathing at birth. The neonate died shortly post-partum due to respiratory failure. Subsequent autopsy showed TMH with small bowel obstruction, distention, and necrosis. High-standing diaphragm with small lungs was the cause of death.