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Management of malignant bowel obstruction

  • Carla Ida Ripamonti
    Correspondence
    Corresponding author: Address. Palliative Care Unit (Pain Therapy-Rehabilitation) IRCCS Foundation, National Cancer Institute, Milano Italy. Tel.: +39 02 23902243; fax. +39 02 23903656.
    Affiliations
    Professor on Contract of Oncology (Teaching Palliative Medicine) at the School of Specialization in Oncology, University of Milan

    Palliative Care Unit (Pain Therapy-Rehabilitation) IRCCS Foundation, National Cancer Institute, Milano Italy
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  • Alexandra M. Easson
    Affiliations
    Assistant Professor of Surgery, University of Toronto, Division of General Surgery, Mount Sinai Hospital, Department of Surgical Oncology, Princess Margaret Hospital Toronto, Ontario Canada
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  • Hans Gerdes
    Affiliations
    Attending Physician, Director of GI Endoscopy, Memorial Sloan-Kettering Cancer Center, and Professor of Clinical Medicine, Weill Medical College of Cornell University
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Published:March 25, 2008DOI:https://doi.org/10.1016/j.ejca.2008.02.028

      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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