Malignant Bowel Obstruction

Question 1

Definition

Answer 1

• clinicals evidence of bowel obstruction
• distal to ligament of Treitz
• presence of intra-or extra-abdominal cancer with peritoneal involvement
• absence of possibilities for cure

Question 2

Common symptoms

Answer 2

• nausea
• vomiting (early with upper GI, late with lower GI)
• colicky pain (due to distention proximal to obstruction, periumbilical - severe pain in spurts; large bowel - less intense, deep pain, longer intervals)
• continuous pain
• dry mouth (drugs with anticholinergic, dehydration)
• constipation
• overflow diarrhea

Question 3

Workup

Answer 3

• obstruction series abdominal XR
• CT abdomen w contrast (detect low grade obstruction, bowel ischemia, disease burden)
• bloodwork for metabolic derangement - CBC, lactate, BMP

Question 4

Management

Answer 4

• palliative sx (usually not feasible)
• endoscopic or IR procedure (stent or gastric tubes)
• medical management:
  - bowel rest
  - NGT
  - TPN (if slow growing tumor, expectation of survival)
  - analgesia and prokinetics for symptom management