Lymphocytic colitis is a rare syndrome of watery diarrhoea, normal colonoscopy findings and mucosal inflammation. The patient does not present with bloody diarrhoea as there is no mucosal ulceration. A 30-year-old male presented with complaints of pain abdomen for 6 months. Ultrasound showed oedematous ileo-cecal junction with ileocolic lymphadenopathy which was managed with antibiotics. He presented again with symptoms of intestinal obstruction in the following month. On laparotomy, there was ileo-cecal thickening for which right hemicolectomy was done. The biopsy report came as lymphocytic colitis. This is a very rare presentation for a case of lymphocytic colitis.

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We present an interesting case of acute intestinal obstruction where a woman, aged 26, presented to emergency room with constipation for 2 days and vomiting for 1 day. The examination and initial imaging suggested sub-acute intestinal obstruction, since the condition progressed she was taken to operating room for laparotomy. The intra-operative findings revealed isolated segmental mega-diverticulosis of ileum. She underwent resection of terminal ileum and caecum with ileo-colic anastomosis. Pathological evaluation of specimen showed diverticular features. Ileal diverticulosis excluding Meckel’s is an extremely rare entity and complicating into acute intestinal obstruction is strange. With a low prevalence and absence of suspicion for it, diagnosis will be made intra operatively most of the time.