Bowel Obstruction

Vignette:

A 76 year-old woman with colon cancer and recent small bowel obstruction refuses hospitalization for symptoms consistent with recurrent obstruction and wishes to remain at home. The patient is vomiting feculent smelling material which is distressing to the patient and family. Can anything be done to help?

Discussion:

There are several medical treatment options for small bowel obstruction. Octreotide, an analog of somatostatin, reduces the secretion of fluids in the intestines and pancreas. Octreotide can be started at 100 mcg SQ every 8 hours and titrated to 2400 mcg daily. A subcutaneous infusion of antiemetic drugs could also be initiated. The choice of drugs is customized and may contain a mixture of different medications such as Dexamethasone 5-20 mg; Famotidine 40 mg; Haloperidol 5-20 mg; Metoclopramide 40-120 mg; Diphenhydramine 25-100 mg and Octreotide. These medications can be mixed together in normal saline to make a 60 ml volume and run over a 24 hour period.

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