Distal intestinal obstruction syndrome

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Distal intestinal obstruction syndrome
Stomach colon rectum diagram-en.svg
Small intestine(at center)

Distal intestinal obstruction syndrome (DIOS) involves obstruction of the distal part of the small intestines by thickened intestinal content and occurs in about 20% of mainly adult individuals with cystic fibrosis. [1] DIOS was previously known as meconium ileus equivalent, a name which highlights its similarity to the intestinal obstruction seen in newborn infants with cystic fibrosis. [2] DIOS tends to occur in older individuals with pancreatic insufficiency. Individuals with DIOS may be predisposed to bowel obstruction, though it is a separate entity than true constipation. [2]

Contents

Signs and symptoms

Signs and symptoms of DIOS include a sudden onset of crampy abdominal pain, vomiting, and a palpable mass (often in the right lower quadrant) in the abdomen. The characteristic abdominal pain is typically located in the center or right lower quadrant of the abdomen. [1] X-rays of the abdomen may reveal stool in the colon and air-fluid levels in the small intestines.[ citation needed ]

Diagnosis

A complete history and physical examination can be suggestive, especially if a palpable mass in the right lower quadrant of the abdomen is present (though this can be present in the absence of DIOS). Ultrasound and computed tomography (CT) imaging of the abdomen can confirm the diagnosis by demonstrating dilated loops of intestine with material in the intestinal lumen with bubbles. [1] Air-fluid levels may be seen in those affected by DIOS. [1]

Classification

DIOS is sometimes classified by the degree of obstruction as incomplete or complete DIOS. [3]

Differential diagnosis

Additional diagnoses which may present with similar symptoms to DIOS include severe constipation, appendicitis, and intussusception. [1]

Management

Differentiation of DIOS from constipation is generally performed by unit specializing in the treatment of cystic fibrosis. Adequate hydration and an aggressive regimen of laxatives are essential for treatment and prevention of DIOS. Osmotic laxatives such as polyethylene glycol are preferred. [1] Individuals prone to DIOS tend to be at risk for repeated episodes and often require maintenance therapy with pancreatic enzyme replacement, hydration and laxatives (if the symptoms are also mild). [4] [5] Oral contrast instillation into the colon/ileum under radiological control has been found to reduce the need for surgical intervention.[ citation needed ]

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<span class="mw-page-title-main">Gastric outlet obstruction</span> Medical condition

Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes, as well as malignant causes, such as gastric cancer.

Stercoral ulcer is an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation due to a large bowel obstruction, damage to the autonomic nervous system, or stercoral colitis. It is most commonly located in the sigmoid colon and rectum. Prolonged constipation leads to production of fecaliths, leading to possible progression into a fecaloma. These hard lumps irritate the rectum and lead to the formation of these ulcers. It results in fresh bleeding per rectum. These ulcers may be seen on imaging, such as a CT scan but are more commonly identified using endoscopy, usually a colonoscopy. Treatment modalities can include both surgical and non-surgical techniques.

Fibrosing colonopathy is a disease that arises in people with cystic fibrosis treated with high doses of pancreatic enzyme supplements. Symptoms are non-specific with abdominal pain, abdominal swelling, vomiting, and constipation.

References

  1. 1 2 3 4 5 6 Kelly, T; Buxbaum, J (July 2015). "Gastrointestinal Manifestations of Cystic Fibrosis". Digestive Diseases and Sciences (Review). 60 (7): 1903–13. doi:10.1007/s10620-015-3546-7. PMID   25648641. S2CID   25453958.
  2. 1 2 Stringer, David A.; Babyn, Paul S. (2000). Pediatric Gastrointestinal Imaging and Intervention. PMPH-USA. p. 347. ISBN   9781550090796.
  3. Feldman, Mark; Friedman, Lawrence S.; Brandt, Lawrence J. (2010). Sleisenger and Fordtran's Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features. Elsevier Health Sciences. p. 945. ISBN   978-1437727678.
  4. Ludwig, Stephen (2008). Visual Handbook of Pediatrics and Child Health: The Core. Lippincott Williams & Wilkins. p.  283. ISBN   9780781795050.
  5. Mighten, Janice (2012). Children's Respiratory Nursing. John Wiley & Sons. ISBN   9781118278277.