Distal Intestinal Obstruction Syndrome (DIOS)

• obstruction of the distal part of the small intestine (cecal area)

• thick intestinal content

• occurs in 20% of adults with cystic fibrosis, especially with pancreatic insufficiency

• Risk factors

  • dehydration​

  • change of diet

  • poor compliance with pancreatic enzymes

• S/Sx: abdominal pain, vomiting, palpable mass in abdomen, Xray show stool in colon and air-fluid level in small intestine (usually affects the right colon)

• difficult to differentiate from constipation

• Tx:

  • enema by fluoroscopy (6-10L)

  • water-soluble (eg. gastrografin) enema instillation reduces surgical intervention

  • hydration

  • laxatives