Successful treatment of distal intestinal obstruction syndrome with N-acetylcysteine and polyethylene glycol via colonoscopy

•Distal intestinal obstruction syndrome may occur in patients with cystic fibrosis.•Most cases improve with conservative medical therapy.•Select patients will need surgery, which carries increased morbidity and mortality.•Administration of NAC and PEG via colonoscopy offers a viable alternative remedy. We describe a case of a 46-year-old woman with cystic fibrosis who presented with several days of abdominal pain and distension. She was found to have a small bowel obstruction with inspissated stool in the distal ileum on CT imaging. Despite initial management with conservative measures, her symptoms worsened. She was taken for urgent colonoscopy with administration of 4% N-acetylcysteine (NAC) and polyethylene glycol (PEG) at the distal ileum with resultant dissolution of the fecalith. Over the following days, her symptoms improved, and she was discharged with outpatient follow-up.