Small bowel volvulus associated with mesenteric rent caused by hemorrhaging right common iliac artery aneurysm

Small bowel volvulus is a rare but serious condition in which a segment of small bowel twists about its mesentery, potentially resulting in obstruction, ischemia, and perforation. In adults, it results most frequently from adhesions and intra-abdominal masses. We present the case of a 76-year-old male presenting to the emergency department with severe abdominal distention, tenderness, and guarding from a small bowel volvulus due to an adjacent mesenteric rent. This was seemingly caused by massive retroperitoneal hemorrhage from a ruptured proximal right common iliac artery aneurysm. "Why should an emergency physician be aware of this?"Although cases of small bowel volvulus associated with mesenteric rents are present in the literature, this appears to be the first precipitated by a ruptured common iliac artery aneurysm.