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.
Keywords
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Article info
Publication history
Published online: March 25, 2008
Accepted:
February 25,
2008
Received:
February 11,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
