EP-565 Four different causes of bowel obstruction in single patient – case report and review of management of small bowel obstruction

Abstract Introduction The most common causes of Small bowel obstruction (SBO) in adults are adhesions, hernias, cancer, Crohn's, Diverticulitis, volvulus, etc; children, intussusception. Overall mortality is 10%, increasing to 30% with complications. Urgent investigation, aggressive medical management and appropriate timely surgery key successful outcome. Aim We present a patient 4 due single pathology, highlight different SBO the aim improving outcomes. Case presentation A 55 year old lady presented SBO, mass RIF. CT demonstrated subacute SBO. Four were found at laparotomy 1. intraluminal lesion proximal jejunum 2. intussuscepting ileal 3. terminal - perforated /adherent pelvic side wall, 4. RIF from ascending colon. Right hemicolectomy + resection (lesions 2, 3, 4) jejunal resection-anastomosis (lesion 1) performed. She made good post- operative recovery. Histology morphological appearances immunoprofile soft tissue sarcoma arising GIT: gastrointestinal clear cell sarcoma/ malignant neuroectodermal tumour. under review specialist regional team. Conclusion There over 22 000 admissions for England/Wales each year; 6.4% result death within 90 days. Depending on cause, may resolve therapy but needed total obstruction, complications such as perforation, ischaemia, or failure conservative therapy. Our case report highlights importance urgent investigations