Perforation of the bowel wall in utero, with meconium gaining access to the tunica vaginalis, results in meconium periorchitis. The clinical and pathologic features in four infants were studied; the findings were compared with those in the 20 cases reported in the literature. In the majority of cases, the intestinal perforation had apparently healed before birth, and the scrotal mass became increasingly obvious following birth. Cystic fibrosis was documented in only one case. A yellowish green paratesticular mass with multifocal dystrophic calcification was the principal gross finding. Lobules of fibromyxoid tissue containing the calcifications were separated by bands of connective tissue. A granulomatous reaction per se was not prominent in the four cases of the present study, although some authors have characterized the process as meconium granuloma. Before orchiectomy is performed in an infant with a scrotal mass, the possibility of meconium periorchitis should be considered.