When you hear hoofbeats, think horses before zebras – a case of recurrent small bowel obstructions with a twist

Mechanical small bowel obstructions (SBOs) account for a considerable proportion of hospital admissions for acute abdominal pain. SBOs are most frequently caused by adhesions; and very few SBOs are associated with intraperitoneal devices. An 84-year-old man was admitted to our tertiary institution with recurrent SBOs that were initially believed to be caused by his implantable cardioverter defibrillator which had undergone intraperitoneal migration. However, this was later found to be a misguided ‘zebra’; as the cause was revealed to be a common ‘horse’ — adhesions. This article shares our key learnings from this diagnostic dilemma.