Small bowel volvulus is a rare but life-threatening surgical emergency. The aetiology may be primary, as is often seen in Africa and Asia, while in Western countries other predisposing conditions usually initiate the volvulus. Early preoperative investigation and expedient surgical treatment is required if bowel infarction is to be prevented. Central abdominal pain resistant to narcotic analgesia should heighten the suspicion of the diagnosis. The diagnostic value of computerised tomography (CT) scanning in such situations has been emphasised. If the bowel is infarcted resection is required, but the optimum treatment for cases with viable small bowel is uncertain, the alternatives either being resection, fixation, or simple derotation.