Malignant Bowel Obstruction

Bowel obstruction in the setting of end stage cancer can result in significant symptom burden for the patient. Addressing these symptoms can be challenging, and the WOCN is often consulted in the process of treatment. This presentation will review the evaluation and treatment options for the patient presenting with bowel obstruction in the setting of abdominal malignancy. Three cases will be used to illustrate the different treatment modalities, including pharmacotherapy to treat nausea and vomiting, and attempt to restore bowel function, the role of stents and diverting ostomies to relieve obstruction and the use of decompression PEG for intractable symptoms.

The first case is a woman with advanced ovarian cancer, s/p multiple courses of chemotherapy, with progression of disease who presents with intractable nause and vomiting, but with occasional passage of gas and stool. Workup reveals an ileus pattern related to carcinomatosis. She is treated with octreotide, metoclopramide, and bisacodyl rectal suppositories, with successful return of bowel function and no need for surgical intervention.

The second case is a woman with progressive colon cancer, who presents with frequent small volume diarrhea, abdominal distention and pain, and nausea with anorexia. She is found to have tumor recurrence low in the sigmoid colon causing a near complete bowel obstruction. Options of diverting colostomy and colonic stent are discussed, and outcome presented.

The third case is a young patient with advanced rectal cancer and diffuse disease spread. She has a colostomy from her initial surgical intervention. She presents with intractable nausea and vomiting and intermittent obstruction of stoma output. Multiple strategies were attempted, but no improvement was made, ultimately resulting in a decision to use decompression PEG for symptom management.