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However, a less well\u2010known entity is distal intestinal obstruction syndrome (DIOS), which is an important cause of obstructive symptoms in people with CF that must be differentiated from other causes of bowel obstruction. However, one confounding factor is that adults with CF may have elements of both DIOS and mechanical bowel obstruction due to adhesions from previous operations. A recent tragic outcome in a young adult with CF highlights the need for all doctors, both junior and senior, especially those who are not directly involved in day\u2010to\u2010day CF care, to understand the features of DIOS and the appropriate management, which differs from that of a mechanical bowel obstruction. This review aims to highlight the clinical and pathophysiological features of DIOS, differentiate it from other causes of bowel obstruction and contrast management strategies. Improved knowledge of DIOS will help to facilitate appropriate recognition and permit optimal, multidisciplinary management of this CF complication.<\/jats:p>","DOI":"10.1111\/ans.15357","type":"journal-article","created":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:19:59Z","timestamp":1564532399000},"page":"681-686","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Distal intestinal obstruction syndrome: an important differential diagnosis for abdominal pain in patients with cystic fibrosis"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2019-5979","authenticated-orcid":false,"given":"Amy","family":"Hort","sequence":"first","affiliation":[{"name":"Department of Surgery Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2625-6939","authenticated-orcid":false,"given":"Ahmer","family":"Hameed","sequence":"additional","affiliation":[{"name":"Department of Surgery Westmead Hospital  Sydney New South Wales Australia"},{"name":"Centre for Transplant and Renal Research The Westmead Institute for Medical Research  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Middleton","sequence":"additional","affiliation":[{"name":"Sydney Medical School The University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Respiratory and Sleep Medicine CF Service, Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9814-0452","authenticated-orcid":false,"given":"Henry C.","family":"Pleass","sequence":"additional","affiliation":[{"name":"Department of Surgery Westmead Hospital  Sydney New South Wales Australia"},{"name":"Centre for Transplant and Renal Research The Westmead Institute for Medical Research  Sydney New South Wales Australia"},{"name":"Sydney Medical School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000357646"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja10.11229"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2016.02.002"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja11.10719"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181a6e01d"},{"key":"e_1_2_13_7_1","first-page":"171","article-title":"Late intestinal obstruction in patients surviving neonatal meconium ileus","volume":"103","author":"Graham WP","year":"1965","journal-title":"Calif. 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