Management of Patients with Inoperable Malignant Bowel Obstruction: A Preliminary Report

Malignant bowel obstruction (MBO) is a distressing complication of advanced cancer with poor survival and substantial symptom burden and often requiring intensive supportive management. Data on its management in lower-middle-income countries (LMICs) are limited. We retrospectively reviewed records of 25 adults with inoperable MBO managed by a palliative care (PC) unit at a tertiary cancer centre in India between November 2021 and October 2023. Demographic, clinical, radiological and treatment data were collected; symptoms at admission and discharge, survival and place of death were recorded. Eighteen patients (72%) were female. Ovarian and gastric cancers were the most common primary malignancies (6 each; 24%), followed by rectal cancer (5; 20%). Abdominal pain (17; 70.8%) and vomiting (15; 62.5%) were the most common symptoms. Nasogastric tubes were inserted in 13 patients (52%), of whom 8 (61%) had them removed before discharge. Dexamethasone (22; 88%) and metoclopramide (21; 84%) were the most frequently used medications. Symptom control at discharge was achieved in 20/23 patients (87%), and 19 (79%) tolerated oral liquids. Nearly 80% died within 60 days of diagnosis. Multidisciplinary medical management with PC involvement was associated with symptom control in most patients with inoperable MBO in this resource-constrained setting.