SHM Converge Scientific Abstract ePoster Gallery-Distal Intestinal Obstruction Syndrome Presenting as Appendicitis

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A 23-year-old man with cystic fibrosis presented with two days of progressive right-sided abdominal pain and dark, tarry stools. His exam showed generalized abdominal tenderness, worse in the right lower quadrant, but he had no fever, vomiting, diarrhea, or constipation. CT imaging suggested appendicitis, showing a dilated appendix with mild inflammatory changes plus thickening of the terminal ileum and colon. He was admitted to surgery and underwent laparoscopic appendectomy. However, prior imaging showed that a similarly dilated appendix and intermittent colonic inflammation had been present before. Surgical pathology later showed a simple mucocele without appendicitis.<br /><br />The case highlights distal intestinal obstruction syndrome (DIOS), a CF-related condition caused by partial or complete obstruction of the bowel by thick intestinal contents. DIOS is thought to be related to dehydration, dietary changes, dysmotility, and inadequate pancreatic enzyme activity. Its classic presentation includes cramping abdominal pain, a right lower quadrant mass, and stool buildup in the distal small intestine and right colon. Because the pain and inflammatory findings often involve the right lower quadrant, DIOS can closely mimic appendicitis.<br /><br />Management of DIOS is usually supportive, focusing on correcting fluid and electrolyte abnormalities and using osmotic laxatives to promote stool passage. Surgery is reserved for patients with peritoneal signs or complications requiring laparotomy and decompression. Long-term prevention includes optimizing pancreatic enzyme replacement, maintaining a bowel regimen, and ensuring adequate hydration.<br /><br />This case emphasizes that DIOS should be considered in patients with cystic fibrosis who present with abdominal pain, even when imaging appears consistent with appendicitis.

Asset Subtitle

Grace I. Ng

Meta Tag

Author List Francis W. Coyne, Grace I. Ng

Category Clinical Vignettes

Concept Distal Intestinal Obstruction Syndrome

Concept Cystic Fibrosis

Concept Abdominal Pain

Concept Appendicitis

Concept Stool Accumulation

Distinguished Finalist

Presenter Organization University of Rochester Medical Center

Presenting Author Grace I. Ng

Track Adult

Keywords

cystic fibrosis

distal intestinal obstruction syndrome

DIOS

appendicitis mimic

right lower quadrant pain

appendectomy

mucocele

terminal ileum thickening

osmotic laxatives

hydration

Distal Intestinal Obstruction Syndrome

Cystic Fibrosis

Abdominal Pain

Appendicitis

Stool Accumulation