Distal intestinal obstruction syndrome mimicking an acute surgical abdomen in an adult with cystic fibrosis

Distal intestinal obstruction syndrome (DIOS) is a recognised gastrointestinal complication of cystic fibrosis that may mimic acute surgical pathology, including appendicitis and bowel obstruction. A man in his 40s with cystic fibrosis, bronchiectasis, gout and chronic kidney disease presented with abdominal pain and vomiting. CT imaging demonstrated obstruction at the ileocaecal valve with colonic thickening, consistent with DIOS. The patient was managed conservatively with intravenous fluids, nasogastric decompression and oral Gastrografin, resulting in resolution of symptoms without surgical intervention. In adults with cystic fibrosis presenting with acute abdominal pain, DIOS should be considered early to avoid unnecessary invasive procedures such as laparotomy. This case highlights the importance of clinician and patient awareness, prompt radiological diagnosis and successful conservative management. Early education regarding constipation and the early symptoms of DIOS may facilitate earlier recognition and presentation.