Later presentation of obstructive colonic adenocarcinoma with both large and small bowel obstruction. This degree of small bowel dilation may be misleading and make it difficult to identify the mass in the splenic flexure causing the obstruction. It is important to run the bowel in both directions, but in the case running the large bowel backwards from the decompressed rectum/sigmoid/descending colon can lead you to the mass and start of the obstructed colon in the distal transverse segment.