On July 2, 2000, a 47-year-old woman was admitted for abdominal pain and vomiting. Peritoneal signs were slightly recognizable and X-ray examination enhanced with Gastorographin demonstrated a bird's beak sign. Based on a diagnosis of sigmoid colon volvulus and strangulated ileus, we conducted a lapar-otomy and found 180-degree counterclockwise torsion of the sigmoid colon with torsion and strangulation of the entire ileum. After sigmoidectomy and intestinal resection of about 5 m, the postoperative course was unevantful. Sigmoid colon volvulus with strangulated ileus of the small intestine is rare and difficult to diagnose preoperatively. The possibility of small intestine torsion in sigmoid colon volvulus should be considered because early diagnosis and surgery are necessary for a favorable outcome.

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