Managing A Blcked Gut
By: Dr Noreen Chan, Consultant
Dept of Palliative Medicine

Bowel obstruction may complicate up to 42% in advanced ovarian cancer and 24% of colorectal cancer. The small intestine is more commonly involved and there may be multiple levels of obstruction. Apart from actual narrowing of the intestinal lumen (mechanical obstruction), the bowel itself may not be moving in an effective, coordinated way to move its contents along (functional obstruction). The episodes of obstruction tend to be recurrent, and wax and wane in severity.

Continuous abdominal pain caused by intra-abdominal tumour occurs in about 90% of cases, and intermittent colic or cramping pain is present 75% of the time. Abdominal distension is variable, as is nausea and vomiting. Patients frequently complain of feeling easily full, and this sensation worsens during as the day goes on.

Surgery may be considered for patients with malignant bowel obstruction. Options include resecting a section of blocked intestine and rejoining the ends, bypassing an obstructed portion or forming a stoma proximal to the obstruction. However, for a variety of reasons, surgery may not always be feasible.

Self-expanding metallic stents have been increasingly used in the management of obstructions in the gastric outlet, proximal small bowel and colon, and may be useful in those patients not suitable for surgery. Contraindications include the presence of multiple sites of stenoses and complications include perforation, bleeding and stent migration.

The pharmacological or medical management of cancer patients with a blocked bowel focuses on relieving nausea, vomiting and pain. A combination of anti-nausea, anti-secretory and pain-relieving medication may be required. If it is not possible to take medication by mouth, it may be administered by continuous infusion through a small needle placed under the skin, using battery-operated pumps that allow patients to stay at home.

Patients can eat and drink whatever they can tolerate; what, how much and how frequently one should eat will vary from person to person. Small, easily digestible snacks or meals, spread throughout the day, are recommended. It is better to avoid high-fibre foods that may be difficult to digest.

Ref. : Ripamonti C, Twycross R, Banes M et al. Clinical practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Supportive Cancer Care (2001) 9: 23-233