Management of Malignant Bowel Obstruction in Cancer Patients

Malignant bowel obstruction (MBO) is a serious complication of advanced intra-abdominal and pelvic malignancies, arising when tumours, peritoneal carcinomatosis or adhesions impede transit through the small or large intestine. Clinically, MBO presents with persistent nausea, vomiting, abdominal pain, distension and inability to tolerate oral intake, often accompanied by fluid and electrolyte imbalances. Management is inherently palliative, aiming to relieve symptoms, maintain dignity and align with patient preferences. Initial assessment encompasses performance status, extent of metastatic disease, prognosis and patient goals. Conservative measures include bowel rest, intravenous fluids and decompression via nasogastric or nasoenteric tubes. Pharmacological regimens employ analgesics, antiemetics, antisecretory agents and somatostatin analogues to reduce gastrointestinal secretions and alleviate pain. Nutritional support ranges from cautious encouragement of oral intake to total parenteral nutrition in carefully selected patients with adequate performance status. Endoscopic stenting and radiologically guided venting gastrostomy provide minimally invasive options for decompression when obstruction is refractory to medical therapy. Surgical interventions—such as resection, bypass or stoma formation—are reserved for those with limited disease burden, acceptable operative risk and estimated survival sufficient to justify potential morbidity. Throughout, multidisciplinary collaboration among oncology, surgery, radiology, nutrition and palliative care teams is essential to tailor therapies, minimise hospital-free days and optimise quality of remaining life across diverse healthcare settings.

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Management of Malignant Bowel Obstruction in Cancer Patients publication trend

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Technical terms

Malignant bowel obstruction: Blockage of the small or large intestine due to tumour growth, carcinomatosis or adhesions, preventing passage of gastrointestinal contents.

Palliative care: Patient-centred care that focuses on symptom relief, psychosocial support and quality of life rather than curative treatment, especially in advanced illness.

Percutaneous venting gastrostomy: A tube placed through the abdominal wall into the stomach under imaging guidance to decompress proximal bowel and relieve obstructive symptoms.

Total parenteral nutrition: Delivery of all essential nutrients intravenously for patients unable to meet nutritional requirements by mouth or enteral routes.

Somatostatin analogue: A synthetic compound mimicking somatostatin, used to reduce gastrointestinal secretions and motility, thereby alleviating symptoms of obstruction.

References

1. CT Fluoroscopy-Guided Percutaneous Gastrostomy in the Palliative Management of Advanced and Relapsed Ovarian Cancer: The Charité Experiences and a Review of the Literature. Cancers (2023).
2. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Supportive Care in Cancer (2022).
3. Inoperable malignant bowel obstruction: palliative interventions outcomes – mixed-methods systematic review. BMJ Supportive & Palliative Care (2022).