Background: The abdominal cavity has an infinite number of potential pathologies and gynecologic pathology is often intertwined with intestinal disease. Case presentation: A 74-year-old female believed to have an adnexal mass on prior imaging presented with small bowel obstruction, which failed to resolve with non-operative management. Given her suspected adnexal mass, multidisciplinary operative intervention was arranged. She was found to have a large, extraluminal mass on her small intestines; serving as the lead point for her midgut volvulus and resultant small bowel obstruction. Conclusion: Physical exam and radiographic discordance should prompt consideration of alternative diagnoses. Making the appropriate initial diagnosis is key in correct patient management; however, this is not always possible and appropriate pre-operative planning should be arranged for best patient outcomes.
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