Presentation
Abdominal pain, BNO for 5 days. Previous medical history of lung transplant. No history of abdominal surgery.
Patient Data
There is a long segment of distal ileum with fecalised content and upstream small bowel dilatation. This segment has a progressive transition to normal distal ileum. Bowel otherwise enhances normally. No free fluid or free gas in the peritoneal cavity.
Gallstones. Fatty replacement of the pancreas. Solid viscera otherwise normal.
Case Discussion
The features are those of distal intestinal obstruction syndrome (DIOS).
The hint for this diagnosis is the fatty replacement of the pancreas and history of lung transplantation, which guide to the diagnosis of cystic fibrosis. The small bowel obstruction happens due to a mucofaeculent material in the distal ileum.