Bowel Obstruction

Medical Management: indicated in patients with multiple sites of obstruction, peritoneal carcinomatosis, advanced disease, poor performance status, inoperable, unstentable
Surgery: indicated in patients with good performance status, slowly progressive cancer and survival estimated at >6 months
Stents: Indicated in patients with good performance status, survival estimated >1 month, colonic obstruction 2cm above anal margin or duodenal obstruction proximal to ligament of Treitz


Needs a combination of medications:

  • Antiemetics: haloperidol +/- metoclopramide (caution in proximal and complete obstructions) see Manage nausea
  • Analgesics: opioid regular + prn s.c. for constant pain – see Manage pain/Opioids
  • Antispasmodic only if severe cramps: hyoscine butylbromide 10-20mg sc tid-qid
  • Corticosteroids: dexamethasone 8-16mg sc once daily in AM trial for 5-7 days – stop if no resolution of obstruction
  • Antisecretory agents: ranitidine 100mg sc bid (as good as octreotide but much cheaper), OR Pantoprazole 40mg IV once daily, OR Octreotide 100-200mcg s.c. bid-tid

Other therapies

  • NPO
  • IV fluids as needed
  • NG can be used temporarily until nausea controlled by medications
  • Venting gastrostomy tube if nausea and vomiting persist