The presentation and subsequent management of 53 patients with volvulus of the small bowel are reviewed. Important features of the presentation are the acute onset of the abdominal pain and its severity which is often inconsistent with the findings on clinical examination. The diagnosis was made preoperatively from plain abdominal x-rays in only 1 patient, although several radiological features are described. In 16 patients there were no obvious predisposing factors, although in the remaining 37 patients the volvulus occurred as a consequence of a predisposing anatomical abnormality. The mortality rate associated with volvulus in the presence of gangrenous small bowel is 47%. In the management of a patient presenting with small bowel obstruction, the possibility of volvulus must be considered in order to reduce this high mortality.