Abstract
A female in her late 20s presented to the emergency department with 1 day of right lower quadrant pain, nausea and emesis. Imaging demonstrated an exophytic right ovarian cyst in addition to small bowel in the pelvis with faecalisation and fat stranding. The patient was taken emergently to the operating room for a joint procedure with the gynaecology team, consisting of a diagnostic laparoscopy and cystectomy. In the operating room, she was found to have small bowel incarcerated within a defect in the pouch of Douglas. This is a rare case in which a small bowel obstruction was caused by an internal hernia within the pouch of Douglas.