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Malignant Bowel Obstruction Management and Feeding Tubes

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
  • Stoma is the hole itself in the abdominal wall that connects to the intestine