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Textbook/Oncology and palliative care/Malignant bowel obstruction/Rapid
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Malignant bowel obstruction

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Perforation, ischaemia or septic obstruction

Continuous severe pain, peritonism, fever, shock, rising lactate, closed-loop imaging, pneumatosis, free gas or progressive organ dysfunction indicates threatened or established bowel necrosis or perforation.

Action: Use ABCDE care, keep nil by mouth, obtain intravenous access and urgent bloods and CT, give protocol antibiotics for sepsis or perforation, decompress vomiting and contact senior surgical and acute-oncology teams immediately; do not delay source control for a complete palliative assessment.

Synopsis

Recognise mechanical and functional bowel failure in advanced cancer, resuscitate and exclude perforation or ischaemia, define level and multiplicity on CT and select surgery, stenting, decompression or symptom-focused medical care.

  • Malignant bowel obstruction may be a single intraluminal stricture, external compression, multifocal peritoneal encasement or diffuse functional ileus; treatment depends on the mechanism.
  • Colicky pain, vomiting, distension and reduced flatus or stool are typical, but partial obstruction can still pass stool and high small-bowel obstruction can vomit before marked distension.
  • First-line definitive imaging is contrast-enhanced CT abdomen and pelvis, which identifies level, transition, multiplicity, tumour burden, closed loop, ischaemia and potential stent or surgical target.

Key red flags

Continuous rather than intermittent pain, guarding, rebound or pain out of proportion raises strangulation, ischaemia or perforation.

Ischaemic conversion

Pain becoming continuous, peritonism, fever, tachycardia, acidosis or shock indicates threatened bowel and needs urgent surgical action.

Investigation priorities

01
First-line contrast CT abdomen and pelvisFirst stepFirst line

Locate and characterise obstruction and identify ischaemia, perforation, multiplicity and procedural options.

Management branches

InitialResuscitate and define anatomy

A person with cancer develops vomiting, colicky pain, distension or failure to pass stool or flatus.

  1. Use ABCDE, keep nil by mouth, establish intravenous access, correct fluid and electrolyte loss, provide analgesia and antiemetic and decompress persistent vomiting with a nasogastric tube.
  2. Obtain contrast CT abdomen and pelvis promptly and repeat examination and lactate while looking for peritonism, closed loop, poor enhancement, free gas or shock.

Key medicines

OctreotideStart octreotide 300 micrograms by continuous subcutaneous infusion over 24 hours for persistent vomiting and high gastrointestinal secretion, titrating within the current specialist palliative-care protocol according to output and symptom response.
Hyoscine butylbromideGive 20 mg subcutaneously as needed for colic and, when recurrent, 60 mg by continuous subcutaneous infusion over 24 hours, titrating to the palliative-care protocol and response.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom