Current therapeutic management of non-surgical malignant intestinal occlusion

Introduction: intestinal or bowel obstruction (BO) is a common complication in terminal cancer patients. When surgery is not an option, therapeutic treatment applies, although there is still no agreed protocol for it. Objective: to analyse the medical treatment of patients with a diagnosis of malignant bowel obstruction when surgery is not an option. Method: retrospective, descriptive study of ten patients who were seen at the Palliative Center Unit of the Oncology Department at the Armed Forces Central Hospital and were diagnosed with malignant bowel obstruction from 1 January, 2009 through 31 December 2010. Results: we classified patients according to their therapeutic response: those whose malignant bowel obstruction evidenced reversion (6/10) and those whose MBO evidenced no reversion (4/10). Average age in the first group was 55 years old, and an adynamic ileus caused the obstruction in 5 out of 6 patients. Therapeutic treatment was initiated between the first and sixth day after symptoms became evident. All patients received dexamethasone, metoclopramide, antacids and analgesics. Five patients also received hyoscine, neostigmine was used in two patients with minimal pain, haloperidol and levomepromazine was used in two patients with intense vomiting. Average survival was 39 days. In the second group, average age was 75 years old. The cause for the MBO was mechanic in two out of the four patients. All patients presented over three comorbilities. All patients received metoclopramide, two of them haloperidol and dexamethasone was used in three patients. Average survival was 9 days Discussion: Good results were obtained thanks to the early initiation of treatment with corticoids, haloperidol, analgesics and neostigmine. These results need to be validated by a prospective study over a larger population.