A strategy for intestinal obstruction of peritoneal carcinomatosis

Obstruction of the small intestine caused by peritoneal carcinomatosis is properly palliated by resection, bypass, and stoma formation. If none of these procedures is applicable, palliation may be achieved by the permanent placement of a long intraluminal decompressive (Baker) tube. Twelve patients have been treated in this manner, nine of them living long enough to exhibit the capacity to eat and drink without repetitive vomiting. The Baker tube was passed across the abdominal wall, inserted into the proximal jejunum, and then passed as far as practical down to the surgically nontreatable obstruction. Venting of the small intestine distally allows continuing decompression, which thereby permits mucosal functions proximally. This technique allows the surgeon to do something beneficial for these unfortunate patients when the established maneuvers of bypass, resection, or stoma formation are pointless.