Distal intestinal obstruction syndrome (DIOS) in cystic fibrosis
Presentation
Recent double lung transplant. Now presents with abdominal pain and distension.
Patient Data
CT abdomen and pelvis
CT confirms the presence of a distal small bowel obstruction. The distal small bowel is distended by hyperdense material seen prolapsing from the terminal ileum into the cecum.
Calcification and pancreatic atrophy are also noted.
Bilateral chest drains in situ in keeping with a recent lung transplant. Peg tube is no longer in the lumen of the stomach. Nasogastric tube has been inserted.
Annotated coronal CT
Hyperdense intestinal content protrudes through the ileocecal valve into the cecum (yellow arrow).
Case Discussion
This case beautifully demonstrates the prolapsing hyperdense bowel content through the ileocecal valve, although to make the diagnosis of DIOS one does not need to see this feature.