This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (26)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Eddie Tang, MD; James Davis, MD; Howard Silberman, MD

Arch Surg. 1995;130(8):832-837.

Abstract
Objective
To examine the efficacy of various interventions on bowel obstruction occurring in patients with a history of cancer.

Design
Retrospective case series.

Setting
A university comprehensive cancer center.

Patients
Sixty-one patients presenting with 81 episodes of intestinal obstruction.

Results
Sixty-nine episodes of obstruction affected the small bowel, including 24 complete obstructions. There were 12 episodes of large-bowel obstruction, eight of which were complete. Five patients (8.2%) had concurrent small- and large-bowel obstruction. In 59 cases, the cause was established: 36 (61%) were due to metastatic tumor and 23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of these 42 cases of obstruction resolved after 8.7±11.1 days (mean±SD) of conservative management. Twenty-two patients with partial obstruction were treated surgically, with relief of obstruction in 15 cases (68%). Of the 32 episodes of complete obstruction, 26 (81%) were initally managed conservatively; in only one case (3.8%) did obstruction resolve. Surgery successfully relieved the obstruction in 16 (76%) of 21 patients. Twenty-six patients received parenteral nutrition at home as the major treatment for obstruction; 22 (85%) experienced relief of nausea and vomiting. Patients with malignant obstructions survived 0 to 24 months (median, 4.7 months); the median survival for those treated surgically was 5.0 months.

Conclusions
In patients with a history of cancer, partial obstruction (but not complete obstruction) frequently resolves with medical management. Surgical intervention relieves most cases of partial or complete obstruction regardless of benign or malignant cause, but survival often is limited in the latter group. The entire intestinal tract should be evaluated in all patients, since 8.2% of patients in this series had concurrent small- and large-bowel obstructions. Home parenteral nutrition often provides symptomatic palliation in patients not amenable to surgical relief.

(Arch Surg. 1995;130:832-837)

Author Affiliations
From the Department of Surgery, University of Southern California (USC) School of Medicine, the USC/Kenneth Norris Jr Cancer Hospital, and the Los Angeles County+USC Medical Center, Los Angeles.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Contrast Enema Before Bypass Surgery for Small-Bowel Obstruction in the Oncologic Patient: Is It Necessary?
Hentel and Gollub
Am. J. Roentgenol. 2003;181:1361-1364.
ABSTRACT | FULL TEXT  

Management of intestinal obstruction in hospice care
Baumrucker
AM J HOSP PALLIAT CARE 1998;15:232-235.
ABSTRACT  

Management of Bowel Obstruction in Patients With Abdominal Cancer
Woolfson et al.
Arch Surg 1997;132:1093-1097.
ABSTRACT  

BOWEL OBSTRUCTION IN CANCER: SURGERY VS. CONSERVATIVE MANAGEMENT
JWatch General 1995;1995:2-2.
FULL TEXT