Gastrointestinal obstruction in palliative care: a review

Open access


Many symptoms are experienced by dying patients. Any symptom can be debilitating and affect the patient’s and the family’s quality of life. Symptom research is complicated, especially in patients receiving palliative care because the studies needed are methodologically challenging. Symptoms management is the essential goal in palliative care. Many people rate this as one of the most important issues whether they are at home, in a hospital or at other assisted care. Bowel obstruction is rarely an emergency, and usually evaluated by multidisciplinary teams. Tailored management is based on the underlying aetiology and pathophysiology. When several symptoms occur together, they can be interrelated and management can be complex. This article discusses the management of intestinal obstruction experienced by palliative care patients

[1] Krouse RS. Surgical management of malignant bowel obstruction. Surg Oncol Clin N Am. 2004; 13:479-490.

[2] Kolomainen DF, Barton DP. Surgical management of bowel obstruction in gynaecological malignancies. Curr Opin Support Palliat Care. 2011;5:55-9.

[3] Chakraborty A, Selby D, Gardiner K et al. Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Manage.2001; 41:412-20.

[4] Ripamonti C. Malignant bowel obstruction. In: Gastrointestinal Symptoms in Advanced Cancer Patients. 2002; Oxford University Press.

[5] Ripamonti C, Mercadante S. Pathophysiology and management of malignant bowel obstruction. Oxford Textbook of Palliative Medicine. 3rd ed. 2003; Oxford University Press.

[6] Hanks GW, Cherny NI, Christakis NA et al. Oxford textbook of palliative medicine. 4th ed. New York, NY: 2010; Oxford University Press.

[7] Downing GM, Wainwright W. Medical care of the dying. 4th ed. Victoria, 2006; BC:Victoria Hospice Society.

[8] Soriano A, Davis MP. Malignant bowel obstruction: individualized treatment near the end of life. Cleve Clin J Med.2011; 78:197-206.

[9] Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer.2008; 44:1105-15.

[10] White SI, Abdool SI, Frenkiel B et al. Management of malignant left-sided large bowel obstruction: a comparison between colonic stents and surgery. ANZ J Surg.2011; 81:257-60.

[11] Taourel PG, Fabre JM, Pradel JAet al. (1995). Value of CT in the diagnosis and management of patients with suspected acute small bowel obstruction. AJR Am J Roentgenol. 165:1187-92.

[12] Mercadante S, Ferrera P, Villari P et al. Aggressive pharmacological treatment for reversing malignant bowel obstruction. J Pain Symptom Manage. 2004; 28:412-6.

[13] Roeland E, von Gunten CF. Current concepts in malignant bowel obstruction management. Curr Oncol Rep.2009; 11:298-303.

[14] Spears H, Petrelli NJ, Herrera L et al.Treatment of bowel obstruction after operation for Colorectal carcinoma. Am J Surg. 1998; 155:383-6.

[15] Foo CC, Poon JT, Law WL. Self-expanding metallic stents for acute left-sided largebowel obstruction: a review of 130 patients. Colorectal Dis.2011; 13:549-54.

[16] Glare PA, Dunwoodie D, Clark K et al. Treatment of nausea and vomiting in terminally ill cancer patients. Drugs.2011; 68:2575-90.

[17] Twycross R. (1995). Symptom management in advanced cancer. 175-9.

[18] Ripamonti C, Panzeri C, Groff L et al. The role of somatostatin and octreotide in bowel obstruction: Pre-clinical and clinical results. Tumouri. 2001; 87:1-9.

[19] Mercadante S, Ferrera P, Villari P et al. Aggressive pharmacological treatment for reversing malignant bowel obstruction. J Pain Symptom Manage.2004; 28:412-6.

[20] Laval G, Girardier J, Lassaunière JM et al.The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction: Palliat Med.2002; 14:3-10.

[21] Feuer J, Broadley E. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer.2008; Cochrane Database of Systematic Reviews.

[22] Mori M, Bruera E, Dev R. Complications of a gastrostomy tube used for decompression of an inoperable bowel obstruction in a patient with advanced cancer. J Pain Symptom Manage.2009; 38:466-72.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 182 182 13
PDF Downloads 85 85 7