Management of malignant bowel obstruction Journal Article
| Authors: | Ripamonti, C. I.; Easson, A. M.; Gerdes, H. |
| Article Title: | Management of malignant bowel obstruction |
| 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. © 2008 Elsevier Ltd. All rights reserved. |
| Keywords: | cancer surgery; ascites; patient selection; treatment planning; pathophysiology; cancer patient; neoplasms; palliative care; unindexed drug; quality of life; computer assisted tomography; nausea; vomiting; chlorpromazine; haloperidol; opiate; palliative therapy; dexamethasone; steroid; symptom; radiology; surgery; physician; stent; world health organization; antiemetic agent; octreotide; antiemetics; intestine obstruction; intestinal obstruction; methadone; morphine; analgesics; decision making; endoscopy; hydromorphone; analgesia; metoclopramide; levomepromazine; prochlorperazine; performance; drug administration routes; somatostatin derivative; abdominal drainage; drainage; gastrostomy; metal; carcinomatosis; analgesic agent; stents; antihistaminic agent; fentanyl; diamorphine; oxycodone; intubation, gastrointestinal; stomach obstruction; endoscopy, gastrointestinal; suction; malignant bowel obstruction; symptom control; gastrointestinal agents; buprenorphine; diatrizoate; cyclizine; scopolamine bromide; scopolamine butyl bromide; skin irritation; advanced/end-stage cancer patients; nasogastric suction; palliative medical treatment; butyrophenone derivative; glycopyrronium bromide; phenothiazine; stomach secretion inhibitor; colic |
| Journal Title: | European Journal of Cancer |
| Volume: | 44 |
| Issue: | 8 |
| ISSN: | 0959-8049 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-05-01 |
| Start Page: | 1105 |
| End Page: | 1115 |
| Language: | English |
| DOI: | 10.1016/j.ejca.2008.02.028 |
| PUBMED: | 18359221 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 30" - "Export Date: 17 November 2011" - "CODEN: EJCAE" - "Source: Scopus" |
