Intestinal non-rotation is an exceedingly rare clinical entity, especially as the etiology for small bowel obstruction following open-heart surgery in an elderly patient. Perisplenitis (also known as "sugar spleen") is also rarely identified during exploratory laparotomy, and is more often encountered post-mortem due to its benign disease course. These two entities were encountered in the same acutely decompensating patient, and while unrelated, serve as a reminder of the importance of recognizing variations in anatomy and understanding subsequent clinical significance.
Keywords: acute care surgery; anatomy.