Background <p>Caecal volvulus occurring in the setting of ileal neobladder reconstruction is rare. We report a case of caecal volvulus occurring after urinary reconstruction to highlight the diagnostic challenges and surgical management.</p> Case presentation <p>We report the case of a 61‑year‑old male who presented with clinical features consistent with small bowel obstruction. Cross‑sectional imaging demonstrated a dilated small bowel with a transition point adjacent to the neobladder and mesenteric crowding suggestive of an internal hernia. The patient underwent exploratory laparotomy, which identified torsion of the caecum around the mesentery of the neobladder. The caecum was then decompressed through an appendectomy and a stapled partial caecectomy was performed followed by closure of the mesenteric defect.</p> Conclusion <p>Caecal volvulus should be considered in patients presenting with acute bowel obstruction after ileal neobladder reconstruction. Awareness of this should prompt early diagnosis and timely intervention to prevent bowel ischemia and reduce morbidity.</p>