A 70-year-old man, who had a medical history of a total gastrectomy with splenectomy for early gastric cancer, came to our hospital complaining of strong abdominal pain that had suddenly emerged an hour before. On physical examination, he showed abdominal pain with muscular defense. The abdominal computed tomography (CT) revealed whirl sign. He was diagnosed with a strangulated ileus, and an emergency operation was performed. On laparotomy, we found milk-colored ascites that indicates chylous ascites. The small intestine was twisted 720 degrees and caused ischemic change. The bowel resection was not necessary because blood flow was quickly recovered after detorsion. We fixed the small intestine to the mesentery of the colon and used an ileus tube as the internal fixation to prevent recurrence. His post-operative course was good without recurrence for over 2 years.