Bowel Obstruction in Terminally Ill Patient

1. See Also
   1. Bowel Obstruction
2. Epidemiology
   1. Mechanical IleusIncidence in Hospice care: 3%
   2. Common end-stage cancer causes
      1. Ovarian Cancer
      2. Colon Cancer
3. Symptoms
   1. Crampy Abdominal Pain from bowel fluid secretion
4. Differential Diagnosis
   1. See Constipation in Cancer
5. Management: Terminally ill, comfort care patients
   1. Surgical Intervention
      1. Usually not indicated for terminally ill
         1. High mortality
         2. High rate of recurrence (50%)
      2. Options to consider
         1. Temporary nasogastric suction
         2. Endoscopic bowel stenting for esophageal obstruction or duodenal obstruction
   2. Specific medications
      1. Octreotide (Sandostatin) 50-100 mcg every 6-8 hours (titrate to effect)
         1. Inhibits bowel fluid secretion
      2. Dexamethasone 6-16 mg IV daily
         1. May resolve a Bowel Obstruction related to edema (e.g. gastrointestinal or Ovarian Cancer)
         2. Continue Corticosteroid indefinately unless compelling reasons to stop the medication
   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)
6. 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
7. References
   1. Ross (2001) Am Fam Physician 64(6):1019-26