Management of malignant bowel obstruction

Carla Ida Ripamonti, Alexandra M. Easson, Hans Gerdes

Research output: Contribution to journalArticlepeer-review

Abstract

Malignant bowel obstruction (MBO) is a common and distressing outcome particularly in patients with bowel or gynaecological cancer. Radiological imaging, particularly with CT, is critical in determining the cause of obstruction and possible therapeutic interventions. Although surgery should be the primary treatment for selected patients with MBO, it should not be undertaken routinely in patients known to have poor prognostic criteria for surgical intervention such as intra-abdominal carcinomatosis, poor performance status and massive ascites. A number of treatment options are now available for patients unfit for surgery. Nasogastric drainage should generally only be a temporary measure. Self-expanding metallic stents are an option in malignant obstruction of the gastric outlet, proximal small bowel and colon. Medical measures such as analgesics according to the W.H.O. guidelines provide adequate pain relief. Vomiting may be controlled using anti-secretory drugs or/and anti-emetics. Somatostatin analogues (e.g. octreotide) reduce gastrointestinal secretions very rapidly and have a particularly important role in patients with high obstruction if hyoscine butylbromide fails. A collaborative approach by surgeons and the oncologist and/or palliative care physician as well as an honest discourse between physicians and patients can offer an individualised and appropriate symptom management plan.

Original languageEnglish
Pages (from-to)1105-1115
Number of pages11
JournalEuropean Journal of Cancer
Volume44
Issue number8
DOIs
Publication statusPublished - May 2008

Keywords

  • Advanced/end-stage cancer patients
  • Malignant bowel obstruction
  • Nasogastric suction
  • Palliative medical treatment
  • Stents
  • Surgery
  • Symptom control

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

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