Management of intestinal obstruction in patients with advanced cancer

Intestinal obstruction is a common and distressing complication for patients with advanced abdominal or pelvic cancer. Palliative surgery has an inevitable high mortality and morbidity rate in these patients who are often very ill. Conservative treatment, using intravenous fluids and nasogastric suction, has not been shown to cause resolution of the obstruction and it involves hospitalisation, immobility and discomfort. Pharmacological treatment, using drugs to control the symptoms of colic, continuous abdominal pain and vomiting, is effective in the majority of patients. They can therefore be cared for at home or in a hospice. A small group of patients, mainly with high obstruction, will benefit from a nasogastric tube or venting gastrostomy and fluids can be given, if needed, by intravenous or subcutaneous infusion.