Abstract A term male neonate with moderate Hypoxic-Ischaemic Encephalopathy (HIE) developed persistent rectal bleeding and rising inflammatory markers during therapeutic hypothermia. Despite conservative management, he deteriorated with signs of colonic ischaemia. Imaging suggested segmental hypoperfusion centred at Griffiths’ point at the splenic flexure, a recognised colonic watershed zone. Emergency laparotomy revealed extensive non-viable colon requiring subtotal colectomy with end ileostomy. Histopathology confirmed transmural ischaemic necrosis. This case highlights the vulnerability of neonatal colonic watershed regions to systemic hypoperfusion and underscores the need for early recognition of gastrointestinal complications in infants with HIE.