Management of gastrointestinal oncologic emergencies for the acute care surgeon: What you need to know

Gastrointestinal (GI) oncologic emergencies are increasingly common as the population ages and as systemic therapies extend the survival of patients with advanced malignancy. The management of these emergencies frequently falls to the acute care surgeon, who must often act on incomplete information, without the benefit of complete staging, a multidisciplinary tumor board, or nutritional optimization, and frequently under considerable time pressure. This review addresses five emergencies most likely to be encountered: malignant bowel obstruction, GI hemorrhage, perforation, biliary obstruction with cholangitis, and neutropenic enterocolitis. Several principles recur across these entities: resuscitation and control of sepsis or hemorrhage take precedence over oncologic considerations; endoscopic and other nonoperative options are often preferable in appropriately selected patients; and recent antiangiogenic therapy, profound neutropenia, and heavy contamination should each lower the threshold for diversion rather than primary anastomosis. The choice of intervention must also account for the altered physiology and disease biology unique to this population, and GOC discussions should be integrated early enough to inform, and not follow, the decision to operate. This review summarizes the available evidence and relevant guidelines to provide a practical framework for individualized decision-making at the bedside. (J Trauma Acute Care Surg. 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).

Level IV, descriptive/narrative literature review.