Introduction: Internal hernia is considered under malrotation or defective rotation of mid-gut. Lack of fixation of the mesentery of the right or left colon may result in the formation of potential spaces. Entrapment of the mid-gut in these peritoneal sacs leads to a mesocolic hernia. Left mesocolic hernia occurs in 75% of internal hernias.

The birth prevalence of congenital heart disease in India is about 9/1000 with Tetralogy of Fallot (TOF) making up 7-32 % of these cases. TOF is the most common cyanotic congenital heart disease. Children with uncorrected TOF presenting for non-cardiac surgery pose several challenges to the anaesthesiologist ue to the altered hemodynamics and mandate a meticulous anaesthetic plan. We report the anaesthetic management of a rare case of a 12-year-old child with uncorrected TOF, who presented to our superspeciality hospital with a brain abscess and underwent a decompressive craniotomy with successful drainage of the brain abscess.