Recent advances in malignant bowel obstruction: an interface of old and new

Abstract

Malignant bowel obstruction continues to be a difficult problem for patients with abdominal and pelvic primary tumors and tumors originating in other sites. The main treatment options consist of surgery, stenting, and pharmacotherapy. Despite recent advances, the impact of available treatment modalities on symptom control, longevity, quality of life, and associated health care costs have not been evaluated rigorously. This article reviews the available data and suggests an approach to the management of this challenging patient population.

Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma

“…Octreotide, a synthetic analog of somatostatin, is administered to manage the symptoms of bowel obstruction and inhibits the release of several gastrointestinal hormones, thereby modulating gastrointestinal functions by reducing gastric and intestinal secretions, slowing down intestinal motility, decreasing bile flow, and increasing the absorption of water and electrolytes thereby reducing bowel distension and vomiting [4,15]. A randomized controlled study, comparing Octreotide with hyoscyamine, scopolamine butylbromide, and opioid demonstrated a statistically significant improvement in nausea, vomiting, and anorexia in the Octreotide group [16].…”

Large bowel obstruction in women with pelvic malignancies. What is the primary?

“…Preoperative nasogastric intubation and intravenous fluid and electrolyte resuscitation is necessary. The value of conservative treatment as the only method of treating malignant obstruction is questionable [2,3]. Variable primary pathology recommended different surgical strategy and adjuvant treatment in the patients studied.…”

“…At operation, locally advanced pelvic tumours, occasionally arising from the uterus and internal genitalia, can be removed en bloc with the rectum and sigmoid colon [1,2]. This procedure was deemed necessary in a selected group of 12 patients presenting with acute malignant bowel obstruction of unknown origin.…”

Role of Steroids in Malignant Bowel Obstruction

“…Anticholinergics (hyoscine, scopolamine, glycopyrrolate) are used to slow peristaltic contractions. [6][7][8] Antisecretory drugs include thesomatostatin analogue (octreotide). 2,7,8 Antiemetics used include dopamine antagonists (haloperidol, metoclopramide, chlorpromazine), serotonin antagonist (ondansetron, granisetron) and steroids (dexamethasone).…”

“…[6][7][8] Antisecretory drugs include thesomatostatin analogue (octreotide). 2,7,8 Antiemetics used include dopamine antagonists (haloperidol, metoclopramide, chlorpromazine), serotonin antagonist (ondansetron, granisetron) and steroids (dexamethasone). 2,7,8 The appropriate and timely medical management of MBO provides spontaneous resolution in more than one-third of patients.…”