SURGICAL PALLIATION OF SMALL BOWEL OBSTRUCTION DUE TO METASTATIC CARCINOMA

  • 1 January 1981
    • journal article
    • research article
    • Vol. 47  (3) , 99-102
Abstract
Patients (73) with small bowel obstruction due to metastatic carcinoma were seen from 1960-1979. Patients (29) were seen in the 1st decade and 44 patients in the 2nd. The most common primary tumor causing metastatic small bowel obstruction was colonic carcinoma, followed by gastric carcinoma. Plain X-ray examinations supplemented by an upper gastrointestinal series with small bowel follow-through were the most useful diagnostic tests. Of these patients 70% [51/73] were initially treated with i.v. fluids and gastrointestinal decompression using a short (32/51) or long (19/51) tube. In 8 of 51 patients, nasogastric decompression relieved the obstruction, but in all but 1 of these patients symptoms and signs of obstruction recurred promptly after tube removal. At laparotomy, the majority of patients underwent either a bypass procedure or resection. The mean survival for the patients bypassed varied from 4-7 mo.; for those that had resection it varied from 5-9 mo. The mortality rate was high-41% in the 1st decade and 25% in the 2nd. Of the last 12 patients, 8 received hyperalimentation before and after surgery. The operative mortality rate was 12.5% and the mean survival was 8 mo. Colonic carcinoma is the most common primary tumor causing metastatic small bowel obstruction. Tube decompression is rarely effective and surgical relief is necessary in the vast majority of cases. Operative mortality was reduced, partially because of more vigorous support, i.e., hyperalimentation, but the mean duration of survival has not changed significantly.

This publication has 2 references indexed in Scilit: