Distal Intestinal Obstruction Syndrome

Aka: Distal Intestinal Obstruction Syndrome, DIOS, Meconium Ileus Equivalent

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II. Epidemiology

  1. Incidence
    1. Occurs in up to 10 to 22% of Cystic Fibrosis patients

III. Mechanism

  1. Small Bowel Obstruction in the ileocecal region in Cystic Fibrosis patients
  2. Triggered by pancreatic insufficiency, dysmotility and Dehydration

IV. Findings

  1. Presents with Right lower quadrant mass

V. Differential Diagnosis

  1. Constipation
  2. Other Small Bowel Obstruction
  3. Volvulus
  4. Intussception
  5. Fibrosing Colonopathy
  6. Appendicitis
  7. Crohns Disease
  8. Malignancy

VI. Imaging

  1. CT Abdomen (first line study)
    1. Diagnostic for Distal Intestinal Obstruction
    2. Evaluates differential diagnosis
  2. Abdominal XRay
    1. Demonstrates obstructive findings, but CT Abdomen is typically required

VII. Management

  1. Incomplete Obstruction
    1. Nonsurgical management
    2. Oral rehydration
    3. Enemas, Osmotic Laxatives and Stool Softeners
    4. Consider osmotic contrast
  2. Complete Obstruction
    1. Nasogastric Tube decompression
    2. Laparotomy with manual decompression of obstruction

VIII. Complications

  1. Intestinal Ischemia
  2. Bowel perforation

IX. References

  1. Uddin and Crawford (2023) Crit Dec Emerg Med 37(9): 15-5
  2. Colombo (2011) J Cyst Fibros 10(suppl 2): 524-8 [PubMed]

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