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Bowel Obstruction in Terminally Ill Patient
Aka: Bowel Obstruction in Terminally Ill Patient, Cancer Related Bowel Obstruction
- See Also
- Bowel Obstruction
- Epidemiology
- Mechanical IleusIncidence in Hospice care: 3%
- Common end-stage cancer causes
- Ovarian Cancer
- Colon Cancer
- Symptoms
- Crampy Abdominal Pain from bowel fluid secretion
- Differential Diagnosis
- See Constipation in Cancer
- 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
- 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
- Adequate pain management
- Titrate Morphine dosage to pain
- Treat associated Nausea and Vomiting
- See Nausea in Cancer
- Haloperidol (Haldol)
- Diphenhydramine (Benadryl)
- Avoid Metoclopramide (Reglan)
- 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
- References
- Ross (2001) Am Fam Physician 64(6):1019-26 [PubMed]