Distal Intestinal Obstruction Syndrome (DIOS)

Fig.2: CT image at the lower cut reveals 'fecalization' of small bowel, and collapsed descending colon. This patient has known cystic fibrosis status post recent lung transplantation. He developed intermittent abdominal distension and diarrhea. He did not have peritoneal irritation sign on physical exam.

Facts


DIOS is short for 'distal intestinal obstruction syndrome'. Also known as meconium ileus equivalent (MIE)

Unique to cystic fibrosis (CF)

10% - 15% of patients with CF

Caused by accumulation of mucous and feces in small bowel and ascending colon
Common in older child or young adult
Predisposing factors: after transplantation (probably due to dehydration and medications), dehydration, pancreatic enzyme supplement cessation, unknown

Radiographic Features

Fecal materials in terminal ileum, cecum and ascending colon
Thickened mucosal fold of bowel

Reference:
1. Moody AR, et al. CT monitoring of therapy for meconium ileus. J Comput Assist Tomogr 1990 (November/December)
2. Agrons GA, et al. Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation. Radiographics 1996 (July)

Image courtesy of our partner RadiologyinThai (http://www.radiologinthai.com)