Bowel obstruction is a common condition in acute surgery. Among the patients, those with a history of cancer consist a particular group. Difficulties in preoperative diagnosis – whether obstruction is benign or malignant and limited treatment options in patients with reoccurrence or dissemination of the cancer are typical for this group.
The aim of the study was to analyze causes of bowel obstruction in patients with history of radical treatment due to malignancy.
Material and methods. Patients with symptoms of bowel obstruction and history of radical treatment for malignancy who were operated in 2nd and 3rd Department of General Surgery JUCM between 2000 and 2014 were included into the study. The patients were divided into 2 groups based on type of mechanical bowel obstruction (group 1 – adhesions, group 2 – malignant process).
Results. 128 patients were included into the study – group 1: 67 (52.3%) and group 2: 61 (47.7%). In the second group bowel obstruction was caused by reoccurrence in 25 patients (40.98%) and dissemination in 36 (59.02%). The mean time between onset of the symptoms of bowel obstruction and the end of treatment for the cancer was 3.7 and 4.4 years, respectively in group 1 and 2 (p>0.05). Median time between onset of the symptoms and admission to Emergency Department was significantly longer in patients with malignant bowel obstruction compared to those with adhesions (11.6 ±17.8 days vs 5.1 ± 6.9 days, p=0.01). Considering type of surgery due to bowel obstruction, in first group in most patients (69.2%) bowel resection was not necessary and in the second group creation of jejuno-, ileo- or colostomy was the most common procedure. Morbidity was significantly higher in second group (45.9% vs 28.26%, p<0.05) but there was no difference in mortality (26% vs 24%, p>0.05). In both groups the most common localization of primary malignancy was colon.
Conclusions. In analyzed group of patients frequency of bowel obstruction caused by adhesions and malignancy was similar. However, in patients with bowel obstruction caused by malignancy morbidity was significantly higher and duration of symptoms was longer. There was no diagnostic procedure which would allow to differentiate the cause of bowel obstruction preoperatively and the diagnosis was made during the operation.
1. Pedziwiatr M, Budzynski P, Stanek M et al.: Mechanical Bowel Obstruction – Changes in Aetiology over the Past 145 Years: A Single Centre Retrospective Cohort Study. Acta Chir Belg 2015; 115(6): 397-403.
2. Dolan EA : Malignant bowel obstruction: a review of current treatment strategies. Am J Hosp Palliat Care 2011; 28(8): 576-82.
3. Kulvatunyou N, Pandit V, Moutamn S et al.: A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. J Trauma Acute Care Surg 2015; 79(3): 393-98.
4. Loftus T, Moore F, VanZant E et al.: A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg 2015; 78(1): 13-9; discussion 19-21.
5. Thompson MW: Acute Small Bowel Obstruction: Role of Radiography, Contrast Studies, and CT. Contemporary Diagnostic Radiology 2015; 38(21): 1-5.
6. Bauer J, Keeley B, Krieger B et al.: Adhesive Small Bowel Obstruction: Early Operative versus Observational Management. Am Surg 2015; 81(6): 614-20.
7. Ceresoli M, Coccolini F, Catena F et al.: Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg 2015; S2-9610(15): 424-29.
8. Khasawneh MA, Eiken PW, Srvantstyan B et al.: Use of the Gastrografin challenge in patients with a history of abdominal or pelvic malignancy. Surgery 2013; 154(4): 769-75; discussion 775-76.
9. Teixeira PG, Karamanos E, Talving P et al.: Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg 2013; 258(3): 459-65.
10. O’Leary EA, Desale SY, Yi WS et al.: Letting the sun set on small bowel obstruction: can a simple risk score tell us when nonoperative care is inappropriate? Am Surg 2014; 80(6): 572-79.
11. Schraufnagel D, Rajaee S, Millham FH: How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg 2013; 74(1): 181-87; discussion 187-89.
12. Laval G, Marcelin-Benazech B, Guirimand F et al.: Recommendations for bowel obstruction with peritoneal carcinomatosis. J Pain Symptom Manage 2014; 48(1): 75-91.
13. Barnett RE, Younga J, Harris B et al.: Accuracy of computed tomography in small bowel obstruction. Am Surg 2013; 79(6): 641-43.
14. Guimaraes MD, Bitencourt AG, Marchiori E et al.: Imaging acute complications in cancer patients: what should be evaluated in the emergency setting? Cancer Imaging 2014; 14: 18.
15. Low RN, Chen SC, Barone R: Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging. Radiology 2003; 228(1): 157-65.
16. Millet I, Taourel P, Ruyer A et al.: Value of CT findings to predict surgical ischemia in small bowel obstruction: A systematic review and meta-analysis. Eur Radiol 2015; 25(6): 1823-35.
17. Ramos-Andrade D, Andrade L, Ruivo C et al.: Imaging the postoperative patient: long-term complications of gastrointestinal surgery. Insights Imaging 2015.
18. Tuca A, Guell E, Martinez-Losada E et al.: Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 2012; 4: 159-69.
19. Ferguson HJ, Ferguson CI, Speakman J et al.: Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond) 2015; 4(3): 264-70.
20. Prost AlDJ, Douard R, Malamut G et al.: Small bowel obstruction in patients with a prior history of cancer: predictive findings of malignant origins. World J Surg 2014; 38(2): 363-69.
21. Jeong WK, Lim SB, Choi HS et al.: Conservative management of adhesive small bowel obstructions in patients previously operated on for primary colorectal cancer. J Gastrointest Surg 2008; 12(5): 926-32.
22. Shariat-Madar B, Jayakrishnan TT, Gamblin TC et al.: Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol 2014; 110(6): 666-69.
23. Paul Olson TJ, Pinkerton C, Brasel KJ et al.: Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 2014; 149(4): 383-92.
24. Abbas SM, Merrie AE : Resection of peritoneal metastases causing malignant small bowel obstruction. World J Surg Oncol 2007; 5: 122.
25. Ripamonti C, Bruera E: Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 2002; 12(2): 135-43.
26. Ripamonti CI, Easson AM, Gerdes H: Management of malignant bowel obstruction. Eur J Cancer 2008; 44(8): 1105-15.
27. Idelevich E, Kashtan H, Mavor E et al.: Small bowel obstruction caused by secondary tumors. Surg Oncol 2006; 15(1): 29-32.
28. Edna TH, Bjerkeset T: Small bowel obstruction in patients previously operated on for colorectal cancer. Eur J Surg 1998; 164(8): 587-92.