Bowel Obstruction Management
Initial Assessment and Imaging
- The National Comprehensive Cancer Network recommends immediately discontinuing all oral laxatives and obtaining plain abdominal radiography (or CT scan if available) to rule out complete bowel obstruction or fecal impaction before any further intervention 1, 2, 3
- Plain abdominal radiography is usually sufficient to establish the diagnosis of bowel obstruction and differentiate between mechanical obstruction, paralytic ileus, and severe constipation 2
- A CT scan is more sensitive and should be considered if surgical intervention is contemplated, as it helps identify the cause and location of obstruction 2
Physical Examination and Patient Evaluation
- The American College of Physicians recommends performing a digital rectal examination to assess for fecal impaction—hard stool on exam requires manual disimpaction or enema rather than oral laxatives 1, 4
- Assess for peritoneal signs that would indicate perforation or ischemia 2
- Evaluate hydration status and check for signs of dehydration 1
Management of Constipation
- Discontinue any constipating medications (opioids, anticholinergics, calcium channel blockers) if medically feasible 1, 3, 4
- Add a stimulant laxative immediately—bisacodyl 10-15 mg orally 2-3 times daily with goal of one non-forced bowel movement every 1-2 days 1, 3, 5
- Continue the existing osmotic laxative (if polyethylene glycol is part of the regimen) as combination therapy is more effective than either agent alone 4
Management of Bowel Obstruction
- Make patient NPO (nothing by mouth) 2
- Initiate IV or subcutaneous fluids for hydration 2, 3
- Pharmacologic management: octreotide 150 mcg subcutaneously twice daily (up to 300 mcg twice daily) 2, 3
- Antiemetics: use agents that do NOT increase GI motility (avoid metoclopramide in complete obstruction); consider ondansetron or haloperidol 1, 2