Proximal small bowel obstruction in a patient with cystic fibrosis: a case report
Affiliation
Univ Arizona, Coll Med, Phoenix Integrated Surg ResidencyUniv Arizona, Coll Med
Issue Date
2019-09-13Keywords
Abdominal painCystic fibrosis
Distal intestinal obstruction syndrome
Small bowel obstruction
Surgical management
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SPRINGEROPENCitation
Alattar, Z., Thornley, C., Behbahaninia, M., & Sisley, A. (2019). Proximal small bowel obstruction in a patient with cystic fibrosis: a case report. Surgical case reports, 5(1), 143.Journal
SURGICAL CASE REPORTSRights
Copyright © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
Background As advancements are made in the management of cystic fibrosis (CF), survival of the CF patient into adulthood has increased, leading to the discovery of previously unknown CF complications. Though gastrointestinal complications of CF, such as distal intestinal obstruction syndrome, are common, this case demonstrates a variant presentation of small bowel obstruction in this population. Case presentation We describe a 42-year-old male with CF who presented with 2 days of worsening upper abdominal pain, emesis, and loss of bowel function. The patient had no history of any prior abdominal surgeries; however, imaging was concerning for high-grade mechanical small bowel obstruction possibly related to internal hernia. Given leukocytosis and diffusely tender abdomen found on further workup, the decision was made to proceed with diagnostic laparoscopy after a brief period of intravenous fluid resuscitation. Intraoperatively, the transition point was found in the mid-jejunum and was noted to be due to kinking of the bowel causing vascular congestion in the proximal portion. Surgical manipulation of the bowel was required for return of normal perfusion and patency. Conclusion Though the exact mechanism cannot be definitively delineated, we speculate that the increased viscosity and prolonged intestinal transit time, characteristic of CF, resulted in inspissated fecal content in the proximal small bowel, which then acted as a lead point for obstruction. Thus, though small bowel obstruction in patients with CF is often attributed to distal intestinal obstruction syndrome, a broader differential must be considered. Early surgical intervention may be necessary to prevent bowel ischemia and subsequent small bowel resection in a patient presenting with concerning clinical and image findings, as was seen in this patient.Note
Open access journalISSN
2198-7793PubMed ID
31520190Version
Final published versionae974a485f413a2113503eed53cd6c53
10.1186/s40792-019-0701-y
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Except where otherwise noted, this item's license is described as Copyright © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
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