A 3-year-old Holstein cow was referred to Cornell for a primary complaint of colic and distended loops of small intestine palpated per rectum. During physical examination, the cow exhibited signs of colic. She was hypothermic and dehydrated with cool distal extremities. A transient ping was present on the right side consistent with gas and fluid filled-small intestine. Rumen contractions and gut sounds were decreased. Rectal and ultrasound examination revealed dilated loops of small intestine. During surgery, a volvulus of the distal flange may have been created during manipulation and exteriorization of the intestines. This displacement was corrected and the cow was recovered, but died the next morning. Necropsy findings included sepsis and diffuse necrohemorrhagic enteritis. The fairly healthy appearance of the bowel at surgery and the diffuse distribution of the necrohemorrhagic enteritis suggest this cow’s primary problem may have been jejunal hemorrhage syndrome, and not a volvulus of the distal flange.