The physiopathology of combined volvulus of sigmoid and small intestine is discussed. In many cases a half-knot is involved, that is to say a "key" between the two ileal and sigmoid loops, difficult to describe with words but easy to understand by the use of a diagram and radiologic and intraoperative images of lesions, of possible assistance when releasing the loops or determining site of section of foot of occluded loops. Of 116 cases of sigmoid volvulus treated in the Treihville hospital, Abidjan between 1972 and 1983, eleven were associated with small intestine volvulus. Of these 11 cases, 9 were treated by emergency ideal colectomy and small intestine resection, with 3 deaths, and 2 by emergency ideal colectomy and small intestine reintegration, with 2 deaths. Operative mortality was therefore high (45%), global mortality being 24%. This is inherent in underdeveloped surgical units and will certainly improve greatly as hospital standing improves.