Malignant bowel obstruction has 3 arms of treatment
- Medical treatment
- Procedural treatment
- Surgical treatment
Medical treatment
- Insertion of NG tube for decompression
- IV fluids for resuscitation as these patients are typically volume deplete and have electrolyte abnormalities
- Anti-emetic use to treat nausea
Procedural treatment
Venting gastrostomy tube
- Used when surgery is not feasible, or when life expectancy is limited
- Typically is used to transition off of NGT, as NGT is not a long term solution; long term risks of NGT use
- Perforation
- Aspiration
- Pneumothorax
- Can be placed
- Endoscopically
- Interventional radiology
- Surgically
- Can be very helpful to decompress, relief gas and to help with N/V
- When tube is clamped patients are recommended to
- Eat pureed foods (pudding, applesauce)
- Soft foods (soft cheese, banana, eggs)
- When tube is unclamped, eat foods that are thinned and pureed in order to prevent the tube from blocking
Endoscopic stent
- Improve symptoms if there is only a single point of obstruction
- This is NOT curative option
- Typically used for patients with colorectal obstruction (i.e. not small bowel obstruction)
Endoscopic ablation
- Use of laser ablation
- Limited literature, not as frequently performed
Surgical Management
Resection
- Indicated if localized disease present
- Simply removing the bowel where the obstruction is present
Bypass
- Indicated if unable to resect bowel due to significant adhesions involving diseased bowel or if affected bowel is lengthy
Stoma creation
- Indicated when distal small bowel and colon are involved and when there is concern that anastomosis will not heal well
- Ostomy is the process by which stool is diverting to the abdominal wall
- Ileostomy – R iliac fossa, mostly liquid contents, connects ileum to abdominal wall
- If one wishes to bypass the entire colon and rectum
- If one wants to protect a distal colorectal, coloanal or ileoanal anastomosis
- Colostomy – L iliac fossa, mostly formed stool, connects colon to abdominal wall
- If one wishes to bypass the distal colon, rectum or anus
- Ileostomy – R iliac fossa, mostly liquid contents, connects ileum to abdominal wall
- Stoma is the hole itself in the abdominal wall that connects to the intestine