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Intestinal obstruction secondary to adhesions in an infant with cystic fibrosis

Mohammed Jawad1, Gillian Klafkowski, Warren Lenney

  • 1Academic Department of Child Health, University Hospital of North Staffordshire, Stoke on Trent, UK.

BMJ Case Reports
|July 31, 2013
PubMed

Insights

Cystic fibrosis (CF) patients can develop intestinal obstruction from surgical causes like adhesions, not just distal intestinal obstruction syndrome (DIOS). Adhesions can form even without prior abdominal surgery, highlighting the need for thorough evaluation.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Cystic Fibrosis Research

Background:

  • Intestinal obstruction is a significant complication in pediatric patients with cystic fibrosis (CF).
  • Distal intestinal obstruction syndrome (DIOS) is the most frequent cause of bowel obstruction in CF patients.
  • Conservative management is typically the first line of treatment for DIOS.

Observation:

  • A 9-week-old infant with CF presented with intestinal obstruction, initially diagnosed as DIOS.
  • Conservative treatment with laxatives and gastrograffin failed, necessitating exploratory laparotomy.
  • Extensive intra-abdominal adhesions were found to be the cause of obstruction, despite no prior surgical history.

Findings:

  • The patient had a history of conservative management for possible necrotizing enterocolitis in the neonatal period.
  • A hypothesis suggests a subclinical bowel perforation during the neonatal period led to adhesion formation.
  • Intra-abdominal adhesions causing obstruction can occur in CF patients without a history of abdominal surgery.

Implications:

  • This case underscores the importance of considering surgical etiologies for intestinal obstruction in CF patients beyond DIOS.
  • It highlights that intra-abdominal adhesions, a surgical cause, can develop in the absence of previous surgical interventions.
  • Early consideration of surgical causes may prevent delayed diagnosis and treatment in pediatric CF patients with bowel obstruction.

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