AB191. 50. Distal intestinal obstructive syndrome in adult patients with cystic fibrosis

Background: Complete or incomplete intestinal obstruction by viscid faecal material in the terminal ileum and proximal colon [distal intestinal obstruction syndrome (DIOS)] is a common complication in cystic fibrosis. Estimates of prevalence range from 5 to 12 episodes per 1,000 patients per year in children, with higher rates reported in adults. DIOS is mainly seen in patients with pancreatic insufficiency, positive history of meconium ileus and previous episodes of DIOS. Treatment consists of rehydration combined with stool softening laxatives or gut lavage with balanced electrolyte solutions.

Methods: We report two cases of DIOS, 19 and 26 years old males who presented to the emergency department with complaints of abdominal pain and vomiting and background history of cystic fibrosis. Examination of the abdomen in both cases revealed distension and mild tenderness centrally. Rectal examination was normal.

Results: Plain films of the abdomen in both cases revealed faecal loading and dilated loops of small bowel. CT abdomen and pelvis showed small bowel obstruction associated with inspissated muco-feculent material related to cystic fibrosis. Both cases were managed conservatively with oral gastrografin contrast liquid to which they responded and were discharged after 2 days of admission to be followed up in the cystic fibrosis clinic.

Conclusions: Surgeons need to be aware of this condition in order to avoid unnecessary surgical intervention.

Keywords: Cystic fibrosis; intestinal obstruction; gastrografin