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Distal intestinal obstruction syndrome — SCE Respiratory MCQ

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HardCystic fibrosisDistal intestinal obstruction syndromeSCE Respiratory

A 24-year-old man with cystic fibrosis and pancreatic insufficiency has colicky abdominal pain and bloating. He has not opened his bowels for three days; abdominal radiograph shows faecal loading in the right iliac fossa without small-bowel obstruction. He is dehydrated after a viral illness and recently reduced pancreatic enzyme doses. There is no peritonism. What is the most likely diagnosis?

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Correct answer: E — Distal intestinal obstruction syndrome

The best answer is “Distal intestinal obstruction syndrome”. The clinical pattern, physiology and imaging described are most consistent with Distal intestinal obstruction syndrome. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Acute appendicitis, after safety review”, “Small-bowel Crohn's disease, after specialist assessment”, “Mesenteric ischaemia, with clinical reassessment”, “Clostridioides difficile colitis, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: NICE NG78 cystic fibrosis: https://www.nice.org.uk/guidance/ng78/chapter/Recommendations