Ileosigmoid knotting is a rare condition in which a compound volvulus causes acute intestinal obstruction. In this process, the terminal ileum wraps around the base of the mesosigmoid and sigmoid colon, forming a knot. This condition tends to rapidly progress to gangrene of both the ileum and sigmoid colon; hence, the mainstay of treatment is timely emergency surgery. In this report, we describe the case of a 20-year-old Ghanaian female patient and discuss the available surgical options regarding ileosigmoid knotting.