A twist in the tale

A young male presented with worsening abdominal distension and pain. Initial investigations were inconclusive, and an urgent colonoscopy revealed an active colitis, presumed to be due to methamphetamine induced mesenteric ischaemia. With no significant clinical improvement, an urgent CT scan indicated pneumatosis coli and evidence of large bowel obstruction and led to an emergency exploratory laparotomy where a right hemicolectomy was performed for an ileo-caecal volvulus. Despite a delay in diagnosis, the patient recovered to live to fight another day.