A middle-aged man presented at 4:00 with tense distended abdomen, severe pain and numb legs. His medical background included poorly controlled insulin-dependent diabetes. Abdominal x-ray showed a massively distended, featureless viscus on the left side of the abdomen thought to be a sigmoid volvulus. CT scan was delayed due to respiratory compromise from diaphragmatic splinting. Nasogastric and flatus tube decompression were attempted. Eventually CT was obtained and provisionally reported as a sigmoid volvulus. Emergency laparotomy was performed due to the risk of impending perforation. Operative findings were of a hugely distended stomach extending into the left iliac fossa almost completely occupying the abdominal cavity. Gastrotomy was used to decompress the stomach. No mechanical obstruction was identified. Postoperatively he had an episode of massive haematemesis thought to be due to sloughing of gastric mucosa. He was taken back to theatre and died on table.