Since the term ‘diaphragm's disease’ was first used in 1988, our knowledge of the disease has expanded. We are reporting on a patient who presented with intermittent incomplete small bowel obstruction. He was diagnosed with multiple small bowel strictures on M2A consistent with NSAID induced diaphragm's disease. This is a 47 year old male who presented with abdominal pain, nausea and vomiting. His pain was dull in nature and periumbilical in location. There were no obvious exacerbating or relieving factors. His PMHX: hypertension, juvenile rheumatoid arthritis and multiple joints replacements. Medications: Norvasc, Maxzide, Naprosyn, Darvocet, Lortab, and Ambien. On physical exam he has multiple joint deformities consistent with Juvenile RA. His Abdomen was distended, tender, with hyperactive bowel sound. He had normal labs. Abdominal and pelvic CT showed multiple dilated fluid filled loops of small bowel without an obvious transition zone or wall thickening. His small bowel follow through showed some dilated loop of bowel in the ileum. During this admission he was treated with NGT decompression and his symptoms improved without surgical intervention. He represented again a few weeks later with similar symptoms. His CT and small bowel follow through were identical to those of the prior admission. He was treated in a similar manner as previously; but once symptoms resolved, we preformed an M2A study. The study showed multiple strictures throughout the small bowel. The capsule was trapped in one of these strictures for a short period of time, but did pass through without any complications. The patient was advised to stop all NSAID's and was started on (Miralax) 2 for constipation. The patient has been followed for two years, on a regular basis, and has not required any further hospitalization or treatment for his GI tract. This is a unique case because of the early detection of small bowel diaphragm's disease along with the cessation of NSAID's saved this debilitated patient from potential small bowel obstruction and the need for surgical intervention.[figure1]Figure