A 20-year case-series of distal intestinal obstruction syndrome at a state-wide cystic fibrosis service.

Abstract

Background: Distal intestinal obstruction syndrome (DIOS) presents significant management challenges for people with cystic fibrosis (pwC). We evaluated the treatment outcomes and identified risk factors associated with the need for surgical intervention in patients admitted with DIOS.

Method: We conducted a retrospective case series of 96 encounters of DIOS over a 20-year period, observing outcomes between cases of medical management versus those requiring for operative intervention. To our knowledge, this is the largest Australian study to review intervention in DIOS.

Results: Among the patients studied, 94.8% were successfully treated non-surgically. Using computed tomography (CT) confirmation of DIOS as the gold standard, only 9.1% of abdominal x-rays were accurate in finding DIOS. Gastrografin was used in half of cases and was associated with a shorter recovery time. One in 16 patients required operative management, with two cases experiencing surgery following prolonged medical treatment. A history of previous laparotomy increased the odds of requiring surgical intervention by 16 times (95% CI: 1.2-209.9, P = 0.035), while a history of meconium ileus increased the odds by 15.6 times (95% CI: 1.2-204.8, P = 0.036). All patients who underwent surgery also had pancreatic insufficiency.

Conclusion: Medical management was successful in the majority of DIOS presentations. Our study emphasizes a low threshold for abdominal CT scans to identify complete DIOS in high-risk patients, particularly those with a history of laparotomy or meconium ileus, who may require surgical intervention. Furthermore, we advocate for the adjunctive use of Gastrografin alongside medical management. Future research should refine protocols for these high-risk groups to improve outcomes and reduce morbidity.