II. Epidemiology
- Mechanical Ileus Incidence in Hospice care: 3%
- Common end-stage cancer causes
III. Symptoms
- Crampy Abdominal Pain from bowel fluid secretion
IV. Differential Diagnosis
V. Management: Terminally ill, comfort care patients
- Surgical Intervention
- Usually not indicated for terminally ill
- High mortality
- High rate of recurrence (50%)
- Options to consider
- Temporary nasogastric suction
- Endoscopic bowel stenting for esophageal obstruction or duodenal obstruction
- Usually not indicated for terminally ill
- Specific medications
- Octreotide (Sandostatin) 50-100 mcg every 6-8 hours (titrate to effect)
- Inhibits bowel fluid secretion
- Dexamethasone 6-16 mg IV daily
- May resolve a Bowel Obstruction related to edema (e.g. gastrointestinal or Ovarian Cancer)
- Continue Corticosteroid indefinately unless compelling reasons to stop the medication
- Octreotide (Sandostatin) 50-100 mcg every 6-8 hours (titrate to effect)
- Adequate pain management
- Titrate Morphine dosage to pain
- Treat associated Nausea and Vomiting
- See Nausea in Cancer
- Haloperidol (Haldol)
- Diphenhydramine (Benadryl)
- Avoid Metoclopramide (Reglan)
VI. Management: Partial Small Bowel Obstruction
- Stool Softener
- Osmotic Laxative
- Nausea and pain management at above
- Restrict Fluids
- Prokinetic agents (e.g. Metoclopramide)
- Consider Corticosteroids
- Avoid Nasogastric Tube if possible