0893: AN EXCEPTIONAL CASE OF SIMULTANEOUS BILATERAL FRAC- TURED NECK OF FEMURS IN A PATIENT WITH MULTIPLE SCLEROSIS T. Srirangarajan*, S. Isopescu. Withybush General Hospital, Haverfordwest, UK. Introduction: This study reports an exceptional case of simultaneous bilateral fractured neck of femurs with minimal trauma in a patient with Multiple Sclerosis (MS). MS is a progressive inflammatory disorder that can lead to disability. The disease has a multi-factorial impact on bone health and a large effect on reduction of bone mineral density (BMD) at the hip. However, assessment and screening of bone health in multiple scle- rosis is lacking consistency. Case: A 72-year-old female with MS presented after a fall with simulta- neous, bilateral, displaced intra-capsular fractured neck of femurs. There were concerns about the physiological stress from bilateral cemented hip hemi-arthroplasty in one operative session. The multidisciplinary consensus was to undergo two separate operations to allow for patient perioperative optimisation in between operations. Discussion: Simultaneous bilateral fractured necks of femurs are rare case presentations. MS is a disabling disease that leads to immobility and muscle wasting. This is the primary contributor to the development of osteoporosis and increased bone resorption at the disabled hip in MS. Steroid use in acute MS has not shown to reduce BMD. To prevent fragility fractures, bone health needs to be evaluated and treated appropriately by doctors caring for patients with MS. 0904: FISHBONE PERFORATION OF THE ILEUM: CASE REPORT AND LITERATURE REVIEW A. Khoury*, G. Humm, A. Shaw, H. Lloyd. Maidstone & Tunbridge Wells NHS Trust, Tunbridge Wells, UK. A 70 year-old man presented with a 24 hour history of central abdominal pain. Initial investigations revealed normal inflammatory markers and plain films. Computed Tomography identified a linear hyper-density crossing the small bowel lumen into the mesentery, suspicious for fishbone. Development of localised peritonism in the right iliac fossa and significant rise in CRP (4 to 226) after 24 hours prompted diagnostic laparoscopy, revealing an inter-loop abscess, adherent to the anterior abdominal wall with perforated distal ileum. The affected ileal loop was resected with primary anastomosis. Ingestion of foreign bodies is not uncommon, although <1% result in hospital admission. A literature search revealed 176 reported cases of intra-abdominal perforation secondary to fishbone ingestion. Our patient’s presentation was delayed, and he appeared well for some time due to the walled off abscess. This case illustrates that a foreign body causing symptoms requires surgical intervention. The alternative is con- servative management; however, complications such as perforation are likely, and fistula tract formation and slow migration may threaten adja- cent organs, as supported by the literature. Further, detection of fish bone on CT is observer dependent, and careful clinical history and a high index of suspicion is required for accurate diagnosis. 0905: A CASE REPORT OF NECROTISING FASCIITIS COMPLICATING HAND FOOT AND MOUTH DISEASE C. Smith*. University of Glasgow, Glasgow, UK. A literature search confirmed no previous cases of necrotising fasciitis (NF) as a complication of Hand Foot and Mouth Disease (HFMD). This report explores the case of a previously well 1-year-old boy who presented to A&E with an acutely swollen right hand in the context of an atypical viral rash affecting the hands and face. He was admitted under plastic surgery and treated with IV antibiotics and fluid resuscitation for sepsis secondary to cellulitis. Following dermatological review of the rash, a clinical diag- nosis of atypical HFMD was made. He continued to deteriorate over the next 12 hours with rapid progression of cellulitis despite intervention. At this point a diagnosis of NF was made and the child underwent emergency exploration and debridement. He required 5 days in paediatric intensive care but has since made a full recovery. Recent reports highlight an increase in atypical cases of HFMD in associ- ation with coxsackie virus A6 infection. This is the first reported case complicated by necrotising infection. Early recognition of necrotising infection reduces morbidity and mortality; clinicians should be aware of the potential for superadded necrotising infection in cases of HFMD. 0925: PRIMARY NEUROENDOCRINE CARCINOMA OF THE URETER: A RARE HISTOLOGY F. Motiwala 1 , O. Karim 2 , H. Motiwala 3 . 1 Papworth Hospital, Papworth Everard, UK; 2 Princess Alexandra Hospital, Portsmouth, UK; 3 Princess Margaret Hospital, Windsor, UK. Aim: Primary neuroendocrine carcinoma of the ureter is an extremely rare condition with up to 30 cases reported in literature. We describe a case of primary neuroendocrine carcinoma of the ureter treated with nephroureterectomy. Method: A 72 year old Caucasian male presented with gross haematuria. Initial CT urogram revealed normal bladder with left hydro- ureteronephrosis and a 9cm mass of the left mid and lower ureter. Cytology revealed probable high grade carcinoma. CT Chest was negative. The patient underwent laparoscopic left nephrectomy, open uretectomy with removal of bladder cuff and left pelvic lymph node dissection. Result: Post-surgical outcome has remained uneventful. Histology confirmed high grade primary neuroendocrine cancer with staging pT3N0MX. Immunostaining confirmed neuroendocrine origin with strongly positive CD56 and Ki67. Conclusion: Primary neuroendocrine carcinoma of the ureter is a rare condition representing only 0.05% of urinary tract malignancies. It is aggressive with poor prognosis owing to local spread and thin ureteric walls. These tumours are unique as ureters are thought to lack neuroen- docrine cells. There is no standardised approach to treatment though consensus dictates early radical resection with adjuvant chemotherapy and radiotherapy as required. This case highlights that early surgical intervention results in good outcome as these patients tend to present with metastases. 0931: AAACUTE CHOLANGITIS: A RARE CAUSE OF EXTRINSIC COMMON BILE DUCT COMPRESSION B. Edgar*. NIMDTA, Belfast, UK. Extrinsic compression of the common bile duct is a commonly considered differential in cases of extrahepatic biliary dilatation. Commonly impli- cated pathologies include pancreatic masses, primary sclerosing chol- angitis and cholangiocarcinoma. The resulting biliary stasis is susceptible to infection, causing acute cholangitis. In this case a 77 year old female presented to the ED with right upper quadrant pain, fevers and vomiting. On examination she was febrile and there was localised tenderness in the right upper quadrant. Blood tests revealed raised inflammatory markers and an obstructive pattern of LFT derangement with hyperbilirubinaemia. An ultrasound scan found extensive intra- and extrahepatic biliary dila- tation without demonstrating a definitive cause. A CT scan revealed an aneurysmal abdominal aorta causing mass effect along the medial border of the distal common bile duct. Due to significant comorbidities this pa- tient was not deemed to be a candidate for surgical intervention and management was therefore conservative with antimicrobials and sup- portive care. This report draws attention to the presence of abdominal aortic aneurysm as a risk factor for extrahepatic common bile duct compression and sub- sequent development of Cholangitis. As such it should be considered as a differential diagnosis in cases of intra-abdominal sepsis with associated right upper quadrant pain. 0939: NUTCRACKER SYDROME: A CASE REPORT AND REVIEW OF MANAGEMENT K. Kayani* 1 , R. Agarwal 1 , N. Mughal 2 , E. Atkins 2 , F. Khan 1 , A. Awopetu 2 . 1 University of Cambridge, Cambridge, UK; 2 Addenbrookes Hospital, Cambridge, UK. Abstracts / International Journal of Surgery 55 (2018) S13eS139 S32