A technique for the surgical treatment of distal intestinal obstructive syndrome by hand-assisted laparoscopy

Travis Abicht, Christian Jones, Garrett Coyan, Steven Stites, Michael Moncure

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Distal intestinal obstructive syndrome (DIOS) is the partial or complete obstruction of the colon or the terminal ileum by abnormally viscous intestinal contents and is a common sequela of cystic fibrosis (CF) in adults. Medical management of this entity is well described, but often falls short for those with signs of peritonitis or bowel ischemia. Current surgical options are not widely reported. These procedures usually require laparotomy, occasionally with enterotomy, and are complicated by the typically poor medical condition of patients with DIOS. A minimally invasive approach to the surgical care of CF patients with DIOS could effectively relieve obstruction refractory to medical management. METHODS: A 39-year-old woman with CF presented with nausea, severe abdominal pain, and obstipation. She was diagnosed with DIOS and underwent aggressive medical management unsuccessfully. The patient underwent successful hand-assisted laparoscopic antegrade milking of a 15-cm obstructive segment of the small bowel into the colon and placement of an appendicostomy tube. This was followed by postoperative administration of antegrade enemas and nasogastric osmotic cathartics. RESULTS: The patient had resumption of bowel function and was subsequently discharged to her hoM.E. CONCLUSIONS: This is a reported case of laparoscopic exploration and treatment for DIOS, and provides a minimally invasive alternative to laparotomy and enterotomy in the treatment of DIOS.

Original languageEnglish (US)
Pages (from-to)e142-e143
JournalSurgical Laparoscopy, Endoscopy and Percutaneous Techniques
Issue number3
StatePublished - Jun 1 2012
Externally publishedYes


  • appendicostomy tube
  • bowel obstruction
  • cystic fibrosis
  • distal intestinal obstructive syndrome
  • hand-assisted laparoscopy

ASJC Scopus subject areas

  • Surgery


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