Unresectable malignancy and bowel obstruction in the acute care surgery patient

Patients with incurable cancer who develop malignant bowel obstruction (MBO) represent a challenge for acute care surgeons. Most of these patients have a poor prognosis and limited survival. Surgical management, in carefully selected patients, may increase survival, alleviate symptoms, and reduce reobstruction. However, any procedures in this setting should be recognized as palliative and management decisions for these patients should be guided by the patient’s personal goals for treatment. Diagnostic work-up, including laboratory and radiographic studies and a thorough history and physical exam, will inform the surgeon as to the potential treatment options. Ultimately, determination of the appropriate surgical approach is made intra-operatively. Management of this difficult clinical scenario requires complex decision making and sophisticated clinical judgment, both inside and outside the operating room.