Lesser sac herniation is a rare phenomenon, where the bowel protrudes through the epiploic foramen into the lesser sac. We describe the case of a 55-year-old male who presented with acute abdominal pain and in whose case the subtle findings of lesser sac herniation were missed during CT scan reporting. Re-review of the images after the patient's condition deteriorated found evidence of herniation, and re-scanning at that point demonstrated progression of the herniation, with bowel obstruction and perforation. The findings of lesser sac herniation complicated by basculetype caecal volvulus were confirmed during laparotomy. The patient underwent right hemicolectomy with primary ileocolic anastomosis.