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

Abstract

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