Your activity: 4 p.v.

An algorithmic approach to clinical management of malignant bowel obstruction in palliative care patients

An algorithmic approach to clinical management of malignant bowel obstruction in palliative care patients
GI: gastrointestinal; TPN: total parenteral nutrition; 5HT3: 5-hydroxytryptamine type 3.
* For most patients with cancer and symptoms suggesting a potential bowel obstruction, imaging and a surgical consultation are warranted unless the patient refuses evaluation or would not be a candidate for any invasive intervention, including surgery or endoscopy. After a thorough surgical evaluation, many patients may be deemed unlikely to benefit from surgery or endoscopic management for anatomic or clinical reasons.
¶ If evidence of perforation or ischemia is present on plain radiography, cross-sectional imaging may not be necessary.
Δ Symptomatic care may include one or more of the following: glucocorticoids, antiemetics (typically haloperidol, not metoclopramide or constipating 5HT3 receptor antagonists), octreotide, anticholinergics, and/or analgesics, with or without GI decompression.
Stenting is not an option when perforation or ischemia is present.
§ Absolute contraindications to surgery in patients with malignant bowel obstruction include recurrent ascites after paracentesis, diffuse palpable abdominal masses, multiple levels of bowel obstruction, recent abdominal surgery demonstrating that corrective surgery is technically impossible, previous surgery showing diffuse metastatic cancer, and involvement of the proximal stomach. Relative contraindications include multiple sites of intraabdominal tumor, low serum albumin, previous abdominal radiation therapy, poor nutritional status, liver or extraabdominal metastases (including pleural or pulmonary metastases producing severe dyspnea), and major renal or hepatic dysfunction.
¥ Conservative care can continue as long as there is no clinical deterioration. The duration of conservative management is generally shorter for complete versus partial obstruction, but this is highly variable.
‡ Sites amenable to stenting include the large bowel, distal ileum, and proximal jejunum.
Graphic 95084 Version 2.0