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Demarest K, Lavu H, Collins E, Batra V. Comprehensive Diagnosis and Management of Malignant Bowel Obstruction: A Review. J Pain Palliat Care Pharmacother 2023; 37:91-105. [PMID: 36377820 DOI: 10.1080/15360288.2022.2106012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant bowel obstruction is a common complication of advanced gastrointestinal, gynecologic, and genitourinary tumors. Patients present with nausea, vomiting, abdominal pain, and constipation. Cross-sectional imaging is essential to make a diagnosis of bowel obstruction. Initial management is conservative with fluid replacement, electrolyte replacement, bowel rest and sometimes nasogastric decompression. Numerous advanced options exist for definitive management, though none are overly promising but nevertheless may improve quality and quantity of life. Surgical bypass, endoscopic stenting, and endoscopic decompression are some of the options with variable efficacy and are employed in select patients. Chemotherapy may be utilized if the bowel obstruction resolves to reduce tumor burden in a limited number of patients. Parenteral nutrition is an option and should typically be used in surgical patients with good functional and nutritional status with limited tumor burden or curative intent. Palliative care and hospice should be discussed in patients with advanced malignancy who present with peritoneal carcinomatosis or multiple levels of obstruction. Overall prognosis of malignant bowel obstruction is poor, and median survival ranges from 26 to 192 days.
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Affiliation(s)
- Kaitlin Demarest
- Kaitlin Demarest, MD, is with, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Harish Lavu, MD, is with the Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Elizabeth Collins, MD, is with the Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Vivek Batra, MD, is with the Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Harish Lavu
- Kaitlin Demarest, MD, is with, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Harish Lavu, MD, is with the Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Elizabeth Collins, MD, is with the Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Vivek Batra, MD, is with the Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Elizabeth Collins
- Kaitlin Demarest, MD, is with, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Harish Lavu, MD, is with the Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Elizabeth Collins, MD, is with the Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Vivek Batra, MD, is with the Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vivek Batra
- Kaitlin Demarest, MD, is with, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Harish Lavu, MD, is with the Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Elizabeth Collins, MD, is with the Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Vivek Batra, MD, is with the Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Sahsamanis G, Mitsopoulos G, Deverakis T, Terzoglou A, Evangelidis P, Dimitrakopoulos G. Neuroendocrine carcinoma as a rare cause of jejunal intussusception in an adult. Management and literature review. J Surg Case Rep 2017; 2017:rjx082. [PMID: 28560024 PMCID: PMC5441243 DOI: 10.1093/jscr/rjx082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/15/2017] [Indexed: 01/18/2023] Open
Abstract
Intussusception of the small bowel is an uncommon condition, with the majority of cases being observed during infancy. A number of points are responsible, with benign and malignant lesions of the small intestine being the most common. Herein, we present the case of a 75-year-old male patient with vague abdominal pain and black stool during defecation, who underwent surgery due to jejunal intussusception. Pathology report demonstrated a neuroendocrine carcinoma as the underlying cause for his condition, with no additional metastases during the initial diagnosis. Although a conservative approach for management of intussusception is viable, the possibility of gastric outlet obstruction and the presence of malignancy as the primary point usually lead to urgent surgery. In the case of malignancy, adjuvant chemotherapy or additional symptomatic therapy with close follow-up may be required depending on tumor's grade and aggressiveness.
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Affiliation(s)
- Georgios Sahsamanis
- 1st Department of Surgery, 401 General Military Hospital of Athens, PC 15561, Greece
| | - Georgios Mitsopoulos
- 1st Department of Surgery, 401 General Military Hospital of Athens, PC 15561, Greece
| | - Titos Deverakis
- 1st Department of Surgery, 401 General Military Hospital of Athens, PC 15561, Greece
| | - Alexandra Terzoglou
- 1st Department of Surgery, 401 General Military Hospital of Athens, PC 15561, Greece
| | - Paschalis Evangelidis
- Department of Anesthesiology, 401 General Military Hospital of Athens, PC 15561, Greece
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