Distal Intestinal Obstruction Syndrome

  • Etiology: lack of pancreatic enzymes in cystic fibrosis patient causing intestinal bowel contents to become thick and stool-like in distal / terminal ileum leading to a distal small bowel obstruction
  • AXR + CT: small bowel obstruction + small bowel stool sign
  • Treatment: water-soluble hyperosmolar contrast enema to reflux contrast into dilated small bowel loops above area of obstruction
  • Clinical: appearance and treatment similar to that of uncomplicated meconium ileus, thus formerly called meconium ileus equivalent

Cases of Distal Intestinal Obstruction Syndrome

AXR and barium enema of distal intestinal obstruction syndrome
AXR (left) shows a distal small bowel obstruction. Water-soluble contrast enema (right) shows the cecum flipped up into the left upper quadrant with the stool-filled terminal ileum outlined by contrast just beneath it.