Intussusception is defined as the telescoping of a segment of the gastrointestinal tract (intussusceptum) into an immediately adjacent distal bowel (intussuscipiens), causing venous congestion, edema, and blood supply reduction. Adult intussusception is a rare entity which can be with or without lead-point. Cases without lead-point frequently occurs in children or adults with celiac disease and Crohn’s disease and with lead point is caused by an underlying neoplasm, benign or malignant frequently presenting with bowel obstruction and acute abdomen. A 41-years-old male presented to our outpatient clinic with a history of recurrent abdominal pain. The clinical presentation and CT scan findings led to the diagnosis of ileoileal intussusception. Subsequently he underwent laparotomy which revealed an ileal intussusception, which was investigated and was found to be of Crohn’s etiology.

Midgut malrotation is a congenital anomaly seen usually in childhood. Its presentation as an acute intestinal obstruction is extremely rare in adults usually identified intra operatively. A high index of suspicion is always required when dealing with any case of acute intestinal obstruction. We report a case of young adult who presented with symptoms of acute intestinal obstruction and was diagnosed intra-operatively as cecal volvulus with impending perforation caused by midgut malrotation. Malrotation of the intestinal tract is seen due to aberrant embryology. The presentation of intestinal malrotation in adults is very rare. Contrast enhanced Computed tomography (CT) can show the abnormal anatomy clearly. Anomalies like midgut malrotation can present as an operative dilemma and awareness regarding these conditions can help surgeons deal with these conditions.