While uncommonly found pathologically together in the adult patient, visceral herniation and gut rotation go hand-in-hand during embryologic development. Rapid growth of the small bowel around week 6 of gestation results in physiologic herniation of the gut through the umbilical ring; the small bowel then rotates a full 270 degrees in a counter-clockwise direction to arrive at its normal anatomic position within the peritoneal cavity. Defects and missteps in these processes can have broad consequences for patients of all ages, as seen in our patient here. Conclusion:Intestinal malrotation can manifest and present throughout adult life -as seen in this rare complication in the setting of another developmental defect. This case highlights the need for appropriate identification, embryological understanding and surgical management of problems such as these in the acute setting.