Introduction: Visceral myopathy is a very rare, poorly understood entity of the gastrointestinal tract mimicking various causes of acute abdomen. Case Presentation: A 40 year-old-female with a chronic history of recurrent partial small bowel obstruction deemed secondary to adhesions presents in extremis with cross sectional imaging defining high grade small bowel obstruction with concern for a transition point. Urgent exploratory laparotomy defines cecal volvulus with right hemicolectomy and ileo-colic anastomosis being performed. Pathology reveals non-caseating granulomas in the ileum as well as within adenopathy in addition to evidence of marked enteritis (Figure 1). She was empirically treated as an acute flare of Crohn's disease with systemic corticosteroids; however, her post-operative course was complicated by recurrent episodes of obstruction suspected at the anastomosis as defined on repeat cross sectional imaging. Ileoscopy fails to demonstrate an obstruction at the anastomosis. Her subsequent hospital course was complicated by pneumonia with acute respiratory failure requiring intubation, candida esophagitis, and fungemia in the setting of systemic corticosteroid use, and pulmonary embolism. Further pathological review demonstrates findings consistent with visceral myopathy (Figure 2) as the etiology of her acute presentation and prior episodes of intestinal pseudo-obstruction. Secondary autoimmune and mixed connective tissue etiologies were excluded during her comprehensive evaluation.Figure 1Figure 2Conclusion: Non-familial visceral myopathy is a rare clinical entity with scant available literature to define clinical outcomes. This case highlights an atypical mimicker of Crohn's disease where early recognition may have proven critical to avoid associated morbidity. Visceral myopathy should be considered in any patient with recurrent episodes of intestinal pseudo-obstruction.Figure 3