Twin to twin transfusion syndrome(TTTS)is caused by aberrant vascular connections between infant twins and results in high morbidity and mortality in the perinatal period.In donor infants with TTTS and symptoms of intestinal obstruction,small-bowel lesions have been reported in most cases.We report on a 33+6 gestational wk donor infant with TTTS who had intermittent obstructive episodes,including delayed meconium passage and colonic dilatation on abdominal X-ray.The diagnosis of Hirschsprung’s disease was based on a lateral pelvic film with a reversed rectosigmoid ratio.A subsequent barium colon study and rectal suction biopsy indicated a short segment aganglionosis of the colon. Twin to twin transfusion syndrome (TTTS) is caused by aberrant vascular connections between infant twins and results in high morbidity and mortality in the perinatal period. In donor infants with TTTS and symptoms of intestinal obstruction, small-bowel lesions have been reported in most cases .We report on a 33 + 6 gestational wk donor infant with TTTS who had intermittent obstructive episodes, including delayed meconium passage and colonic dilatation on abdominal X-ray. The diagnosis of Hirschsprung’s disease was based on a lateral pelvic film with a reversed rectosigmoid ratio .A subsequent barium colon study and rectal suction biopsy indicated a short segment aganglionosis of the colon.