A 71-year-old man was admitted with features of intestinal obstruction. His past surgical history included an appendicectomy as a child and three laparotomies. A CT scan of the abdomen revealed a high attenuation foreign body impacted in the distal ileum, associated with small bowel obstruction. At laparotomy, a bone was removed from the terminal ileum.

A 58-year-old man presented acutely with features of post-surgical adhesive small bowel obstruction. Following an unsuccessful trial of conservative management, computed tomography (CT) of the abdomen was performed. This revealed a mass in the ileocaecal region, for which he underwent a subsequent right hemicolectomy. Histology revealed diffuse B-cell Non-Hodgkin’s lymphoma of the terminal ileum. Confounding obstructive lesion of the intestine in patients with a history of previous laparotomy is extremely uncommon. Early high resolution imaging may predict diagnosis and consolidate clinical management plans.

The authors present an unusual case of a 44 year old man who initially presented with urinary symptoms and underwent a CT scan of his abdomen, which showed an incidental finding of terminal ileal intussusception, which was investigated and found to be Crohn's related.