Familial Mediterranean fever (FMF) complicated by adhesive small bowel obstruction: a diagnostic challenge

Familial Mediterranean fever (FMF) is an autosomal recessive auto-inflammatory disorder that primarily affects individuals of Mediterranean, Middle Eastern and South Asian origin . We report the case of a male patient in his late 20s who was diagnosed with FMF at the age of 17 years. Prior to the diagnosis, he underwent two unnecessary surgical interventions due to recurrent episodes of acute abdominal pain-an appendectomy, followed 3 years later by a negative exploratory laparotomy for suspected adhesive small bowel obstruction (SBO). Subsequently, the patient underwent a third laparotomy for CT-confirmed adhesive SBO, during which stricture bands were identified, leading to small bowel resection. Postoperatively, the patient experienced worsening abdominal pain and a prolonged postoperative ileus without significant clinical improvement. This case highlights the diagnostic challenge of distinguishing FMF-related abdominal attacks from surgical causes of acute abdomen.