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Bowel Obstruction in Terminally Ill PatientAka: Cancer Related Bowel Obstruction

See Also
1. Bowel Obstruction
Epidemiology
1. Mechanical Ileus Incidence in Hospice care: 3%
2. Common end-stage cancer causes
  1. Ovarian Cancer
  2. Colon Cancer
Symptoms
1. Crampy Abdominal Pain from bowel fluid secretion
Differential Diagnosis
1. See Constipation in Cancer
Management: Terminally ill, comfort care patients
1. Surgery usually not indicated for terminally ill
  1. High mortality
  2. High rate of recurrence
2. Inhibit bowel fluid secretion
  1. Octreotide (Sandostatin)
3. Adequate pain management
  1. Titrate morphine dosage to pain
4. Treat associated Nausea and Vomiting
  1. See Nausea in Cancer
  2. Haloperidol (Haldol)
  3. Diphenhydramine (Benadryl)
  4. Avoid Metoclopramide (Reglan)
Management: Partial Small Bowel Obstruction
1. Stool Softener
2. Osmotic Laxative
3. Nausea and pain management at above
4. Restrict Fluids
5. Prokinetic agents (e.g. Metoclopramide)
6. Consider Corticosteroids
7. Avoid Nasogastric Tube if possible
References
1. Ross (2001) Am Fam Physician 64(6):1019

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.