Malignant bowel obstruction — Rapid | Doctor's Passport Education

Synopsis

Diagnose mechanical obstruction and its complications, assess whether surgery, stent or venting can achieve meaningful benefit, and provide coordinated non-oral analgesic, antiemetic, antisecretory, corticosteroid, hydration and mouth care when medical management is chosen.

Suspect malignant obstruction with colic or continuous pain, distension, nausea, vomiting, reduced flatus or stool and known intra-abdominal or pelvic cancer.
First-line safety assessment looks for peritonitis, ischaemia, perforation, strangulated hernia, aspiration, sepsis, severe dehydration and renal injury.
Contrast CT abdomen and pelvis is the gold-standard investigation for site, completeness, number of levels, complications, tumour burden and interventional planning.

Key red flags

Peritonism, shock, fever, rapidly worsening continuous pain or lactate rise requires urgent surgery and sepsis assessment.

Complicated obstruction

Peritonism, shock, fever, continuous escalating pain or lactate rise suggests ischaemia, perforation or sepsis.

Investigation priorities

First-line abdominal and hernia examinationFirst stepFirst line

Assess stability, hydration, distension, focal or colicky pain, peritonism, masses, scars, hernias, bowel sounds and rectal loading.

Management branches

Emergency assessmentExclude strangulation, perforation and sepsis

Obstruction symptoms accompany continuous severe pain, peritonism, instability, fever or rapid deterioration.

Use ABCDE care, stop oral and enteral intake, obtain access and blood tests and call urgent surgical and acute oncology teams within the treatment ceiling.
Arrange immediate CT or operative decision, give protocol antimicrobial and resuscitation care when indicated and provide non-oral analgesia and antiemetic.

Key medicines

Octreotide for obstructive secretionStart 300 micrograms over 24 hours by continuous subcutaneous infusion in many palliative protocols, titrating commonly within 300 to 600 micrograms daily according to output and specialist advice.

Hyoscine butylbromide for colic and secretionGive 20 mg subcutaneously as needed and use 60 to 120 mg over 24 hours by continuous infusion when repeated benefit and local compatibility guidance support it.

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