Bowel obstruction

Patients with colon or ovarian cancer make up the bulk of those developing small or large bowel obstruction. In a colon cancer patient, confirmation of incurability will usually be made at laparotomy, following a decision to treat a large bowel obstruction. Where possible, these patients should have the primary cancer excised and intestinal continuity restored by primary anastomosis. Management of the obstructed ovarian cancer patient is usually more difficult as the key decision is often whether or not the patient should have the operation.

Many patients will have multiple obstruction sites, with their small and large bowel studded with tumours on the serosal surface. Such patients are not suitable for surgical palliation. Others will have 1 or 2 site obstructions e.g. a segment of terminal ileum embedded in pelvic tumour. They can benefit from debulking, resection, and anastomosis or bypass surgery.

Differentiating these categories of patient can usually be done by a history of crampy abdominal pain, clinical examination revealing a distended tympanitic abdomen (as opposed to an abdomen with multiple sites of palpable tumour and ascites), plain X-rays revealing many loops of distended bowel with air fluid levels and CT evidence of pelvic or other single-site tumour deposit.

Laparoscopy will sometimes be helpful in the obstructed patient who has not had previous abdominal surgery.

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